Healthcare Provider Details

I. General information

NPI: 1992697213
Provider Name (Legal Business Name): KATHERINE PACIFICO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 N ORANGE AVE STE 200
ORLANDO FL
32804-5505
US

IV. Provider business mailing address

1790 JUNEBERRY ST
CLERMONT FL
34715-6884
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-1812
  • Fax: 407-303-1815
Mailing address:
  • Phone: 407-914-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11038753
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: