Basic Information
| Provider Information | |||||||||
| NPI: | 1720428113 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CABRERA | ||||||||
| FirstName: | KATHERYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12780 WATERFORD LAKES PKWY | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328284500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073841053 | ||||||||
| FaxNumber: | 4072778168 | ||||||||
| Practice Location | |||||||||
| Address1: | 12780 WATERFORD LAKES PKWY | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328284500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073841053 | ||||||||
| FaxNumber: | 4072778168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2013 | ||||||||
| LastUpdateDate: | 01/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 9191623 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | ARNP9191623 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | APRN9191623 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.