Healthcare Provider Details

I. General information

NPI: 1669392296
Provider Name (Legal Business Name): KATIA COLBURN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATIA RIVERA

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 GREEN FOREST CT STE 14
WINTER GARDEN FL
34787-4444
US

IV. Provider business mailing address

PO BOX 97
GOTHA FL
34734-0097
US

V. Phone/Fax

Practice location:
  • Phone: 407-923-8955
  • Fax:
Mailing address:
  • Phone: 407-923-8955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN3405552
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: