Provider Demographics
NPI:1356940431
Name:DR. KATINA HEALTH AND WELLNESS, INC
Entity type:Organization
Organization Name:DR. KATINA HEALTH AND WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAVIS-KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-231-8700
Mailing Address - Street 1:1204 SANTA CATALINA LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-6311
Mailing Address - Country:US
Mailing Address - Phone:954-231-8700
Mailing Address - Fax:954-231-8707
Practice Address - Street 1:2901 CORAL HILLS DR STE 330
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4165
Practice Address - Country:US
Practice Address - Phone:954-231-8700
Practice Address - Fax:954-231-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1046154000Medicaid