Katrina D. Black, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9110311 Issued in FL

Practice address

3345 S Dale Mabry Hwy
Tampa, FL 33629-7817

Phone

(813) 234-0100

NPI assigned

Mar 14, 2011

Last updated

Aug 6, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Katrina D. Broomfield Former name

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Urgent Care Centers of Brevard County LLC

  dba Health First AdventHealth Centra Care

  • Urgent Care Clinic/Center
  • Maitland, FL
  • NPI 1295367290
  Medicare reassignment NPD
• Adventist Health System Sunbelt, Inc.

  dba AdventHealth Centra Care

  • Urgent Care Clinic/Center
  • Maitland, FL
  • NPI 1073565610
  Medicare reassignment
• Global Physician Network LLC Series II

  • Emergency Medicine Physician
  • Sarasota, FL
  • NPI 1821518028
  Medicare reassignment
• Adventist Health System/ Sunbelt, Inc.

  dba AdventHealth Centra Care - Southern Trace

  • Urgent Care Clinic/Center
  • The Villages, FL
  • NPI 1396605440
  NPD
• Adventist Health System/Sunbelt, Inc.

  dba AdventHealth Centra Care - Ormond Beach

  • Urgent Care Clinic/Center
  • Ormond Beach, FL
  • NPI 1235637471
  NPD
• Urgent Care Centers of Brevard County LLC

  dba Health First AdventHealth Centra Care Melbourne

  • Urgent Care Clinic/Center
  • Melbourne, FL
  • NPI 1801594858
  NPD

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

{
    "created_epoch": "1300060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628208000000",
    "number": "1801194972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 BRIGHTON BAY BLVD NE APT 3104",
            "city": "SAINT PETERSBURG",
            "state": "FL",
            "postal_code": "337163490",
            "telephone_number": "912-292-7116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3345 S DALE MABRY HWY",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336297817",
            "telephone_number": "813-234-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KATRINA",
        "middle_name": "D.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-14",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "004612",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9110311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATRINA",
            "last_name": "BROOMFIELD",
            "middle_name": "D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dalles Raydell Black
• Gregory Black, MD
• Jennifer Black, IBCLC
• Jennilee Harriet Black
• Katie Rene Black, RD
• Shannon Black
• Suellen M Black, ARNP
• Alexis Blackburn
• Julie T Blacker, MS, OTR/L
• Andra Blackheart, LCSW

• Medical Physician Assistant in Tampa, FL
• Providers in Tampa, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.