Provider Demographics
NPI:1861103483
Name:LIPTAK, KATELYN NICOLE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:NICOLE
Last Name:LIPTAK
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:
Other - Last Name:DULEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6150 DIAMOND CENTRE CT # 400
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4367
Mailing Address - Country:US
Mailing Address - Phone:239-561-9191
Mailing Address - Fax:
Practice Address - Street 1:6150 DIAMOND CENTRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4367
Practice Address - Country:US
Practice Address - Phone:239-561-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023349363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology