Healthcare Provider Details

I. General information

NPI: 1659935328
Provider Name (Legal Business Name): RABECCA KATUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

13500 LARANJA ST
CLERMONT FL
34711-8703
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-6611
  • Fax:
Mailing address:
  • Phone: 352-573-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11003329
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9280902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: