Provider Demographics
NPI:1114292257
Name:FORHOLT, KATHERINE M (APRN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:FORHOLT
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:231 NORWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3154
Mailing Address - Country:US
Mailing Address - Phone:321-243-7715
Mailing Address - Fax:
Practice Address - Street 1:111 N ORANGE AVE STE 800
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32801-2381
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9273175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0FZ6OtherFLORIDA BLUE (BCBS)
FL9416992OtherAETNA
FLP01165503OtherRR MEDICARE
FL9273175OtherSTATE ARNP LICENSE NUMBER
FLP01165503OtherRR MEDICARE