Provider Demographics
NPI:1447515739
Name:HERRERA, KATIE LYNN (ARNP/CNM)
Entity type:Individual
Prefix:MS
First Name:KATIE
Middle Name:LYNN
Last Name:HERRERA
Suffix:
Gender:F
Credentials:ARNP/CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N NARCOOSSEE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-8784
Mailing Address - Country:US
Mailing Address - Phone:407-498-3350
Mailing Address - Fax:321-842-4859
Practice Address - Street 1:1132 KELTON AVE
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3175
Practice Address - Country:US
Practice Address - Phone:407-635-3299
Practice Address - Fax:407-636-7829
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4565896363LW0102X
FLARNP9280963367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007386000Medicaid
FLHW208ZMedicare PIN