Healthcare Provider Details

I. General information

NPI: 1063637031
Provider Name (Legal Business Name): KATHY M FAIR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY M VIOLINO CNM,APRN

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 MEADOWS RD STE 325
BOCA RATON FL
33486-2349
US

IV. Provider business mailing address

875 MEADOWS RD STE 325
BOCA RATON FL
33486-2349
US

V. Phone/Fax

Practice location:
  • Phone: 561-237-8877
  • Fax: 561-738-5592
Mailing address:
  • Phone: 561-237-8877
  • Fax: 561-738-5592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN2151572
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN2151572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: