Provider Demographics
NPI:1043843279
Name:ETIENNE, NATACHA (APRN)
Entity type:Individual
Prefix:
First Name:NATACHA
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 PROSPERITY FARMS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33403-2046
Mailing Address - Country:US
Mailing Address - Phone:561-847-4794
Mailing Address - Fax:561-847-4574
Practice Address - Street 1:1706 CARRIAGE BROOKE DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6150
Practice Address - Country:US
Practice Address - Phone:561-847-4794
Practice Address - Fax:561-847-4574
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL00000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner