Provider Demographics
NPI:1548040405
Name:JUAT, KATRINA CLARISSE PAREDES (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KATRINA CLARISSE
Middle Name:PAREDES
Last Name:JUAT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13389 ADLER ST
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-5100
Mailing Address - Country:US
Mailing Address - Phone:760-486-1094
Mailing Address - Fax:
Practice Address - Street 1:16143 KOKANEE RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1355
Practice Address - Country:US
Practice Address - Phone:760-242-6442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2023089915363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily