Healthcare Provider Details

I. General information

NPI: 1992364913
Provider Name (Legal Business Name): KATIE VU APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 MANATEE AVE W
BRADENTON FL
34205-8805
US

IV. Provider business mailing address

316 MANATEE AVE W
BRADENTON FL
34205-8805
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-2277
  • Fax: 941-748-1958
Mailing address:
  • Phone: 941-748-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11035060
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: