Provider Demographics
NPI:1730268111
Name:NETTERSTROM, CATHERINE MARY (ARNP-BC)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MARY
Last Name:NETTERSTROM
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-574-9111
Mailing Address - Fax:
Practice Address - Street 1:1223 GATEWAY DR STE 2H
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2607
Practice Address - Country:US
Practice Address - Phone:321-574-9111
Practice Address - Fax:321-751-9362
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2939332363LF0000X
FLAPRN2939332363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLLY083OtherMEDICARE