Provider Demographics
NPI:1952937955
Name:MOUNTAIN, CATHY J (RN)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:J
Last Name:MOUNTAIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5207 TURTLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-3036
Mailing Address - Country:US
Mailing Address - Phone:941-323-4842
Mailing Address - Fax:
Practice Address - Street 1:5207 TURTLE CREEK LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-3036
Practice Address - Country:US
Practice Address - Phone:941-323-4842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-21
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL861342163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice