Provider Demographics
NPI:1235830043
Name:VARGAS, KATRINA JEAN (NP)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:JEAN
Last Name:VARGAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23456 FORRESTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-3632
Mailing Address - Country:US
Mailing Address - Phone:574-596-6896
Mailing Address - Fax:
Practice Address - Street 1:990 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-3622
Practice Address - Country:US
Practice Address - Phone:574-267-7169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013633A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health