Provider Demographics
NPI:1205015674
Name:WINTLE, KATHERINE A (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:WINTLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3554
Mailing Address - Country:US
Mailing Address - Phone:954-989-3500
Mailing Address - Fax:954-989-3511
Practice Address - Street 1:4310 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3554
Practice Address - Country:US
Practice Address - Phone:954-989-3500
Practice Address - Fax:954-989-3511
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9104336363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant