Provider Demographics
NPI:1013126853
Name:LELLI, KATRINA L (RPAC)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:L
Last Name:LELLI
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-1020
Mailing Address - Country:US
Mailing Address - Phone:772-888-1880
Mailing Address - Fax:855-618-2315
Practice Address - Street 1:1400 NW FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-1020
Practice Address - Country:US
Practice Address - Phone:772-888-1880
Practice Address - Fax:855-618-2315
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1PKD4OtherFLORIDA BLUE
P00819028OtherRAILROAD MEDICARE PIN
P00819028OtherRAILROAD MEDICARE PIN
P00819028OtherRAILROAD MEDICARE PIN