MEDICARE: MRS. KATIE ANNE SHERRILL ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	ARNP9219650	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912305020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATIE ANNE SHERRILL ARNP

Provider Business Mailing Address
First Line	:	8931 LAKE DR APT 501
Second Line	:
City	:	CAPE CANAVERAL
State	:	FL
Zip	:	32920-4294
Country	:	US
Telephone Number	:	321-474-3409
Fax Number	:

Provider Business Practice Location Address
First Line	:	8320 W SUNRISE BLVD STE 208
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-5432
Country	:	US
Telephone Number	:	800-640-3451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2014
Last Update Date	:	01/16/2025

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