Provider Demographics
NPI:1861609752
Name:LAVICKA, CATHERINE L (ARNP)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:L
Last Name:LAVICKA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9595 BEARFOOT TRL
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6480
Mailing Address - Country:US
Mailing Address - Phone:352-592-2403
Mailing Address - Fax:352-597-0550
Practice Address - Street 1:14540 CORTEZ BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6056
Practice Address - Country:US
Practice Address - Phone:352-597-4000
Practice Address - Fax:352-597-0550
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1057642363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1057642OtherARNP LICENSE
FLQ44919Medicare UPIN