Provider Demographics
NPI:1841005964
Name:FLUCAS NORTON, KATRINA MICHELLE
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:MICHELLE
Last Name:FLUCAS NORTON
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 1:827 FOOTMAN LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-8078
Mailing Address - Country:US
Mailing Address - Phone:448-213-5778
Mailing Address - Fax:
Practice Address - Street 1:827 FOOTMAN LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-8078
Practice Address - Country:US
Practice Address - Phone:448-213-5778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities