Provider Demographics
NPI:1902143787
Name:WUBNEH, KATRINA (PA-C)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:WUBNEH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:1400 S ORANGE AVE # MP700
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2134
Mailing Address - Country:US
Mailing Address - Phone:321-841-1858
Mailing Address - Fax:321-843-6498
Practice Address - Street 1:1400 S ORANGE AVE # MP700
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2134
Practice Address - Country:US
Practice Address - Phone:321-841-1858
Practice Address - Fax:321-843-6498
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9109028363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016555800Medicaid
FL016555800Medicaid