Healthcare Provider Details

I. General information

NPI: 1114292257
Provider Name (Legal Business Name): KATHERINE M FORHOLT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE M CRAIG APRN

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N ORANGE AVE STE 800
ORLANDO FL
32801-2381
US

IV. Provider business mailing address

231 NORWOOD AVE
SATELLITE BEACH FL
32937-3154
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 321-243-7715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9273175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: