Healthcare Provider Details

I. General information

NPI: 1801469028
Provider Name (Legal Business Name): KATRINA MARIE ROBERTSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2021
Last Update Date: 01/03/2024
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8832 US HIGHWAY 90
DAPHNE AL
36526-8932
US

IV. Provider business mailing address

8333 N DAVIS HWY
PENSACOLA FL
32514-6050
US

V. Phone/Fax

Practice location:
  • Phone: 251-263-9820
  • Fax: 251-263-9821
Mailing address:
  • Phone: 850-474-8320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116559
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.2163
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: