Provider Demographics
NPI:1568073740
Name:VIRTUSIO, KATHRINA (MD)
Entity Type:Individual
Prefix:
First Name:KATHRINA
Middle Name:
Last Name:VIRTUSIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 GRANDE DR APT 821
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8955
Mailing Address - Country:US
Mailing Address - Phone:850-712-1173
Mailing Address - Fax:
Practice Address - Street 1:2102 TOWN ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-5118
Practice Address - Country:US
Practice Address - Phone:850-432-4745
Practice Address - Fax:850-434-0395
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE31947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine