Individual provider · NPI-1
Katerina Fagan, ACNPC-AG
Urology · Crestview, FL
NPI number1356911671
StatusActive
Last updated in NPPESMay 19, 2026
Details
- NPI
- 1356911671
- Entity type
- Individual (NPI-1)
- Name
- Katerina Fagan
- Credential
- ACNPC-AG
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 29, 2021
- Certification date
- May 19, 2026
- Last updated
- May 19, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208800000X | Urology | 11031708 | FL | Yes |
| 363LA2100X | Nurse Practitioner, Acute Care | APRN11031708 | FL | |
| 363LA2100X | Nurse Practitioner, Acute Care | 1046195 | TX |
Practice location
435 Brookmeade DrCrestview, FL 32539-7304
Phone 850-605-0550 · Fax 850-605-0440
Mailing address
Po Box 1027Niceville, FL 32588-1027
Phone 850-605-0550 · Fax 850-605-0440
Other practice locations
320 Racetrack Rd Nw Ste 100c
Fort Walton Beach, FL 32547-1796
Fort Walton Beach, FL 32547-1796
Phone 850-863-0883
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