Healthcare Provider Details

I. General information

NPI: 1609683085
Provider Name (Legal Business Name): KATHERINE DINGLE SOTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE ANNE DINGLE

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4761 W ATLANTIC AVE
DELRAY BEACH FL
33445-3838
US

IV. Provider business mailing address

7095 NW 4TH AVE
BOCA RATON FL
33487-2386
US

V. Phone/Fax

Practice location:
  • Phone: 561-337-1588
  • Fax:
Mailing address:
  • Phone: 561-400-5109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11036830
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: