Provider Demographics
NPI:1467988220
Name:BORNER, KATRINA PENDLETON (ARNP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:PENDLETON
Last Name:BORNER
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:PENDLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1005 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-6600
Mailing Address - Fax:850-862-0977
Practice Address - Street 1:1005 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6707
Practice Address - Country:US
Practice Address - Phone:850-863-6600
Practice Address - Fax:850-862-0977
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9354301363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021145900Medicaid
FLNI7EDOtherFL BLUE