Provider Demographics
NPI:1205415718
Name:NEWBORN, KATHERINE SHERICE (CNA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SHERICE
Last Name:NEWBORN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 CURRY FORD RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2417
Mailing Address - Country:US
Mailing Address - Phone:252-375-5177
Mailing Address - Fax:
Practice Address - Street 1:932 MEAD AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5644
Practice Address - Country:US
Practice Address - Phone:252-375-5177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-03
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL377163172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker