MEDICARE: KATE LOFTIS PA

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	363A00000X	Physician Assistant	PA9108171	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114329729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE LOFTIS PA

Provider Business Mailing Address
First Line	:	5158 HAWKSTONE DR
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-5416
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 CYPRESS EDGE DR STE 102
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-8454
Country	:	US
Telephone Number	:	386-586-4280
Fax Number	:	386-586-4286

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

Provider Enumeration Date	:	09/25/2014
Last Update Date	:	11/15/2018

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Practice Location Address:

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1659390235 — TIMOTHY E QUINN MD
Practice Location Address:

120 CYPRESS EDGE DR STE 209
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1588980346 — DR. SONIA ISABEL MILLAN PINZON MD
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Directions to “ KATE LOFTIS PA” Practice Location

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