Provider Demographics
NPI:1134598238
Name:SPADA, KATIE A (APRN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:A
Last Name:SPADA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:QUINTAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11802 TEMPEST HARBOR LOOP
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3821
Mailing Address - Country:US
Mailing Address - Phone:401-480-2941
Mailing Address - Fax:941-303-5552
Practice Address - Street 1:11802 TEMPEST HARBOR LOOP
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-3821
Practice Address - Country:US
Practice Address - Phone:941-676-3440
Practice Address - Fax:941-375-7909
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6386363LF0000X
FLARNP9441409363LF0000X
FLAPRN9441409363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily