Provider Demographics
NPI:1952500902
Name:PUIG, KATHERINE MARIE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MARIE
Last Name:PUIG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 ANSON LN
Mailing Address - Street 2:#102
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6016
Mailing Address - Country:US
Mailing Address - Phone:321-439-9255
Mailing Address - Fax:
Practice Address - Street 1:508 N MILLS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5353
Practice Address - Country:US
Practice Address - Phone:407-228-8066
Practice Address - Fax:407-228-8438
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1474682363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health