Healthcare Provider Details

I. General information

NPI: 1548520596
Provider Name (Legal Business Name): CATHY CHRISTINE VERGARA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 SW 116TH PL
OCALA FL
34476-4416
US

IV. Provider business mailing address

4840 SW 116TH PL
OCALA FL
34476-4416
US

V. Phone/Fax

Practice location:
  • Phone: 352-834-5996
  • Fax: 352-204-1506
Mailing address:
  • Phone: 352-369-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP9202636
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9202636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: