Provider Demographics
NPI:1609838119
Name:MCDERMOTT, CATHERINE I (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:I
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:I
Other - Last Name:MCDERMOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:3902 E STATE ROAD 64
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-9059
Mailing Address - Country:US
Mailing Address - Phone:941-756-1200
Mailing Address - Fax:941-756-1200
Practice Address - Street 1:3902 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9059
Practice Address - Country:US
Practice Address - Phone:941-756-1200
Practice Address - Fax:941-739-9358
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2022-07-26
Deactivation Date:2018-12-20
Deactivation Code:
Reactivation Date:2018-12-31
Provider Licenses
StateLicense IDTaxonomies
CT000159367A00000X
CT000637363LA2200X
FL9371180363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004243672Medicaid
FLHU107AMedicare PIN