Provider Demographics
NPI:1215352026
Name:MCGOVERN, CATHY (APRN)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:LUALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4600 BAYOU BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-1901
Mailing Address - Country:US
Mailing Address - Phone:850-477-9253
Mailing Address - Fax:850-494-9843
Practice Address - Street 1:4600 BAYOU BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-1901
Practice Address - Country:US
Practice Address - Phone:850-477-9253
Practice Address - Fax:850-494-9843
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9186009363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care