MEDICARE: KATINA L. BOYNTON RN

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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	RN9395658	FL
2	163W00000X	Registered Nurse	RN9395856	FL

General Provider Information

NPI Number	:	1508572280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATINA L. BOYNTON RN

Provider Business Mailing Address
First Line	:	9403 SE RANDALL CT APT A
Second Line	:
City	:	HOBE SOUND
State	:	FL
Zip	:	33455-2076
Country	:	US
Telephone Number	:	561-396-6044
Fax Number	:

Provider Business Practice Location Address
First Line	:	1961 STOUT ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80294-1961
Country	:	US
Telephone Number	:	303-844-7118
Fax Number	:

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

Provider Enumeration Date	:	01/26/2023
Last Update Date	:	01/26/2023

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