Provider Demographics
NPI:1285470344
Name:BACATAN, KATHRYN GAY D (FNP)
Entity type:Individual
Prefix:
First Name:KATHRYN GAY
Middle Name:D
Last Name:BACATAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 JASMINE WAY
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-6163
Mailing Address - Country:US
Mailing Address - Phone:727-481-7415
Mailing Address - Fax:
Practice Address - Street 1:1460 JASMINE WAY
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-6163
Practice Address - Country:US
Practice Address - Phone:727-481-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily