Provider Demographics
NPI:1174504484
Name:DRAKE, KATIE E (DO)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:E
Last Name:DRAKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3251 N MCMULLEN BOOTH RD STE 303
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2022
Mailing Address - Country:US
Mailing Address - Phone:727-725-6110
Mailing Address - Fax:727-669-9742
Practice Address - Street 1:3251 N MCMULLEN BOOTH RD STE 303
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2022
Practice Address - Country:US
Practice Address - Phone:727-725-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000013683GOtherHUMANA
FL016080000Medicaid
FL16304OtherBC/BS OF FLORIDA
FL389141OtherAVMED
FLI39466Medicare UPIN
FL16304TMedicare PIN