Provider Demographics
NPI:1063272052
Name:CALDWELL, NATASHA MACK (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:MACK
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:MACK
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:1071 CASCADE CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-8084
Mailing Address - Country:US
Mailing Address - Phone:321-987-0472
Mailing Address - Fax:
Practice Address - Street 1:576 W KING ST
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7402
Practice Address - Country:US
Practice Address - Phone:321-987-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9277119163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse