Provider Demographics
NPI:1083603112
Name:FALCO, KATIE M (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:M
Last Name:FALCO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15725 SE 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-5103
Mailing Address - Country:US
Mailing Address - Phone:352-629-0137
Mailing Address - Fax:352-694-4824
Practice Address - Street 1:1801 SE 32ND AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5532
Practice Address - Country:US
Practice Address - Phone:352-629-0137
Practice Address - Fax:352-694-4824
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2165402363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3014606--00Medicaid
FLS13586Medicare UPIN
FLY5391YMedicare ID - Type Unspecified