Individual provider Active NPI

Katelyn Pacocha

  • Neonatal Nurse Practitioner
  • Hollywood, FL
National Provider Identifier
1386376762
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal Nurse PractitionerTaxonomy code 363LN0000X
License
11021525 Issued in FL
Practice address
1005 Joe Dimaggio Dr
Hollywood, FL 33021-5402
Phone
(484) 574-4554
NPI assigned
Jun 25, 2022
Last updated
Oct 4, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal Nurse Practitioner 363LN0000X 11021525 FL Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

1005 Joe Dimaggio Dr
Hollywood, FL 33021-5402

Mailing address

6049 Winding Lake Dr
Jupiter, FL 33458-3777
Phone (484) 574-4554

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251230000501 DE Practitioner - Nurse Practitioner 7012403033 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

PO Box
Suite 191
Wilmington, DE 19899

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
C1-0028750DEMDOphthalmology Physician
11021525FLMDNeonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
The Nemours Foundation CurrentSince Dec 1, 2025 Accepting new patients
The Nemours Foundation CurrentSince Dec 1, 2025 Accepting new patients
The Nemours Foundation Past Accepting new patients

Locations

1600 Rockland Rd
Wilmington, DE 19803

Interoperability endpoints

  • Direct secure messaging: kpacocha106004@direct.nemours.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1386376762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6049 WINDING LAKE DR",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334583777",
            "telephone_number": "484-574-4554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 JOE DIMAGGIO DR",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330215402",
            "telephone_number": "484-574-4554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACOCHA",
        "first_name": "KATELYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-25",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "FL",
            "license": "11021525",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.