Healthcare Provider Details

I. General information

NPI: 1548093651
Provider Name (Legal Business Name): KATRINA M GREY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8590 POTTER PARK DR
SARASOTA FL
34238-5440
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-921-6618
  • Fax: 941-922-0556
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11034581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: