Provider Demographics
NPI:1518667088
Name:YAKUBOWSKI, KATIE (RN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:YAKUBOWSKI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4481 BOWSTRING CT
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-1016
Mailing Address - Country:US
Mailing Address - Phone:321-684-9684
Mailing Address - Fax:
Practice Address - Street 1:4481 BOWSTRING CT
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-1016
Practice Address - Country:US
Practice Address - Phone:321-684-9684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9567973163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse