MEDICARE: KATRINA LEE BASIC FNP-C, EMT-P

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	41.420072	IL
2	146L00000X	Paramedic	000471490	IL
3	363LF0000X	Family Nurse Practitioner	209.025190	IL

General Provider Information

NPI Number	:	1043939747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA LEE BASIC FNP-C, EMT-P

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-1614
Fax Number	:	239-343-3695

Provider Business Practice Location Address
First Line	:	11009 S SAINT LOUIS AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-3321
Country	:	US
Telephone Number	:	773-710-2569
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2022
Last Update Date	:	04/07/2026

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