Healthcare Provider Details

I. General information

NPI: 1427662444
Provider Name (Legal Business Name): JACQUELYN BLISS KATCHUK SEXTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N BAYSHORE DR
SAFETY HARBOR FL
34695-3128
US

IV. Provider business mailing address

3690 ENTERPRISE RD E
SAFETY HARBOR FL
34695-5409
US

V. Phone/Fax

Practice location:
  • Phone: 727-491-5900
  • Fax: 727-330-2556
Mailing address:
  • Phone: 727-599-5370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08200527
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: