Provider Demographics
NPI:1639767908
Name:MORAN, KATIE (FNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MORAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12103 NIGHT JASMINE CV
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-9319
Mailing Address - Country:US
Mailing Address - Phone:954-806-8267
Mailing Address - Fax:
Practice Address - Street 1:5905 US 301 S
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3800
Practice Address - Country:US
Practice Address - Phone:727-822-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9563869163W00000X
FLAPRN11012356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse