Healthcare Provider Details

I. General information

NPI: 1629836168
Provider Name (Legal Business Name): KATALINA MICHELLE BARTELT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 NORTH RD
TULLY NY
13159-3319
US

IV. Provider business mailing address

708 NORTH RD
TULLY NY
13159-3319
US

V. Phone/Fax

Practice location:
  • Phone: 786-519-8218
  • Fax:
Mailing address:
  • Phone: 786-519-8218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9120890
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: