Provider Demographics
NPI:1376567677
Name:FITZGERALD, KATHERINE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:
Last Name:FITZGERALD
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 1:6000 SOUTHWEST 62ND AVENUE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4717
Mailing Address - Country:US
Mailing Address - Phone:305-801-7643
Mailing Address - Fax:305-665-8884
Practice Address - Street 1:6000 SOUTHWEST 62ND AVENUE
Practice Address - Street 2:SUITE 350
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4717
Practice Address - Country:US
Practice Address - Phone:305-801-7643
Practice Address - Fax:305-665-8884
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3294092163W00000X
FL3294092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3034071-00Medicaid
FL3034071-00Medicaid
FLP33978Medicare UPIN