Provider Demographics
NPI:1245829662
Name:DE SOLO, CATRYNA NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:CATRYNA
Middle Name:NICOLE
Last Name:DE SOLO
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 1:7001 SW 97TH AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1407
Mailing Address - Country:US
Mailing Address - Phone:305-273-7998
Mailing Address - Fax:305-273-7275
Practice Address - Street 1:7001 SW 97TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1407
Practice Address - Country:US
Practice Address - Phone:305-273-7998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant