Healthcare Provider Details

I. General information

NPI: 1700710035
Provider Name (Legal Business Name): KATLEYA AIDA PATTUGALAN CAGAYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12735 GRAN BAY PKWY W STE 204
JACKSONVILLE FL
32258-4499
US

IV. Provider business mailing address

11522 SUMMER BROOK CT
JACKSONVILLE FL
32258-2553
US

V. Phone/Fax

Practice location:
  • Phone: 888-754-0398
  • Fax:
Mailing address:
  • Phone: 904-882-9744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: