Provider Demographics
NPI:1619211265
Name:FRAZZETTA, KATHERINE ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:FRAZZETTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:WATTAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:162 BLUE FLAX PT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3467
Mailing Address - Country:US
Mailing Address - Phone:407-766-2776
Mailing Address - Fax:407-657-7942
Practice Address - Street 1:1890 STATE ROAD 436 STE 255
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2285
Practice Address - Country:US
Practice Address - Phone:407-657-7900
Practice Address - Fax:407-657-7942
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107163363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9107163OtherSTATE LICENSE
FLPA9107163OtherSTATE LICENSE
FLPA9107163OtherSTATE LICENSE