Provider Demographics
NPI:1871365189
Name:WASHINGTON, KATINA
Entity type:Individual
Prefix:
First Name:KATINA
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9765 SOUTHBROOK DR APT 2502
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0409
Mailing Address - Country:US
Mailing Address - Phone:904-229-2293
Mailing Address - Fax:
Practice Address - Street 1:9765 SOUTHBROOK DR APT 2502
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0409
Practice Address - Country:US
Practice Address - Phone:904-229-2293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver