Provider Demographics
NPI:1679291777
Name:GRADEVA, KATERINA VASILEVA (APRN)
Entity Type:Individual
Prefix:
First Name:KATERINA
Middle Name:VASILEVA
Last Name:GRADEVA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1400 E OAKLAND PARK BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4400
Mailing Address - Country:US
Mailing Address - Phone:954-561-6222
Mailing Address - Fax:954-990-7650
Practice Address - Street 1:7200 CAMINO REAL STE 201
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5511
Practice Address - Country:US
Practice Address - Phone:561-674-0885
Practice Address - Fax:561-674-0856
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2022-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL11021196363LP0808X
FLAPRN11021196363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health