Healthcare Provider Details

I. General information

NPI: 1124894811
Provider Name (Legal Business Name): KATHERINE UJVARY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 MEMORIAL MEDICAL PKWY STE 401
DAYTONA BEACH FL
32117-5169
US

IV. Provider business mailing address

770 W GRANADA BLVD STE 101
ORMOND BEACH FL
32174-5179
US

V. Phone/Fax

Practice location:
  • Phone: 386-231-3540
  • Fax: 386-231-3544
Mailing address:
  • Phone: 484-526-6643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11037371
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: