Healthcare Provider Details

I. General information

NPI: 1215840251
Provider Name (Legal Business Name): KATHERINE ENSLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2251 TOWN CENTER AVE STE 101
MELBOURNE FL
32940-6105
US

IV. Provider business mailing address

3577 PENINSULA CIR
MELBOURNE FL
32940-1112
US

V. Phone/Fax

Practice location:
  • Phone: 321-805-6803
  • Fax:
Mailing address:
  • Phone: 321-805-6803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11051120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: