Provider Demographics
NPI:1104573955
Name:BATISTA, NATHALIE
Entity type:Individual
Prefix:
First Name:NATHALIE
Middle Name:
Last Name:BATISTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12254 DAWN VISTA DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3329
Mailing Address - Country:US
Mailing Address - Phone:347-615-8120
Mailing Address - Fax:
Practice Address - Street 1:467 LAKE HOWELL RD
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-5922
Practice Address - Country:US
Practice Address - Phone:407-449-2813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician