Provider Demographics
NPI:1760721617
Name:MARSHALL, KATHERINE V (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:V
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6738
Mailing Address - Country:US
Mailing Address - Phone:954-538-6868
Mailing Address - Fax:954-538-6850
Practice Address - Street 1:680 NORTH UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-538-6868
Practice Address - Fax:954-538-6850
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106869363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical