Provider Demographics
NPI:1578277125
Name:GORMAN, KATRIN (APRN)
Entity Type:Individual
Prefix:
First Name:KATRIN
Middle Name:
Last Name:GORMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NW 69TH CIR UNIT 21
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2327
Mailing Address - Country:US
Mailing Address - Phone:561-676-9575
Mailing Address - Fax:
Practice Address - Street 1:100 NW 69TH CIR UNIT 21
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2327
Practice Address - Country:US
Practice Address - Phone:561-676-9575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily