Healthcare Provider Details

I. General information

NPI: 1801407713
Provider Name (Legal Business Name): KATHERINE M OWEN APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1549 AIRPORT BLVD STE 340
PENSACOLA FL
32504-8635
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-2340
  • Fax: 850-416-2338
Mailing address:
  • Phone: 904-450-6063
  • Fax: 904-539-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11008617
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: