Provider Demographics
NPI:1477897338
Name:ELEFTHEROPOULOS, KATRINA PAM (PA-C)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:PAM
Last Name:ELEFTHEROPOULOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 61148
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32236-1148
Mailing Address - Country:US
Mailing Address - Phone:904-400-6100
Mailing Address - Fax:904-400-6102
Practice Address - Street 1:12311 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2673
Practice Address - Country:US
Practice Address - Phone:904-262-7211
Practice Address - Fax:904-262-6995
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106866363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant