Provider Demographics
NPI:1780187682
Name:LLOYD, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:LLOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:CENTURY
Mailing Address - State:FL
Mailing Address - Zip Code:32535-0399
Mailing Address - Country:US
Mailing Address - Phone:850-256-5314
Mailing Address - Fax:850-256-4433
Practice Address - Street 1:8401 N CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:CENTURY
Practice Address - State:FL
Practice Address - Zip Code:32535-1631
Practice Address - Country:US
Practice Address - Phone:850-256-5314
Practice Address - Fax:850-256-4433
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9349196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily