Healthcare Provider Details

I. General information

NPI: 1780210682
Provider Name (Legal Business Name): KATELYN PETITFILS JOUBERT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 W NEWBERRY RD
GAINESVILLE FL
32605-4305
US

IV. Provider business mailing address

112 SOHO CIR
LAFAYETTE LA
70508-4200
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-2020
  • Fax: 352-627-4299
Mailing address:
  • Phone: 337-349-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS21123
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: