Provider Demographics
NPI:1831363605
Name:NOLES, KATRINA F (ARNP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:F
Last Name:NOLES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 N DAVIS HWY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2341
Mailing Address - Country:US
Mailing Address - Phone:850-477-8109
Mailing Address - Fax:850-478-2412
Practice Address - Street 1:1717 N E ST
Practice Address - Street 2:SUITE 308
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-6339
Practice Address - Country:US
Practice Address - Phone:850-436-4563
Practice Address - Fax:850-436-4570
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2830562363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL309137600Medicaid
AL059198761OtherBLUE CROSS BLUE SHIELD
P00617292OtherRR MEDICARE
FLAJ469ZMedicare PIN