Provider Demographics
NPI:1255096343
Name:SOINE, KATHERINE ANITA
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANITA
Last Name:SOINE
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 1:2020 CHAUCER LN
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-7074
Mailing Address - Country:US
Mailing Address - Phone:720-448-8858
Mailing Address - Fax:
Practice Address - Street 1:2020 CHAUCER LN
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-7074
Practice Address - Country:US
Practice Address - Phone:407-274-1788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11022542363LP0808X
FL11022542363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11022542OtherAPRN
FLRN9544571OtherRN
FLAPRN11022542OtherAPRN