Provider Demographics
NPI:1104971266
Name:MOORE, NATASHA PUGH (CRNA)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:PUGH
Last Name:MOORE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:PUGH MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6383
Mailing Address - Country:US
Mailing Address - Phone:813-350-7244
Mailing Address - Fax:813-350-7246
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6383
Practice Address - Country:US
Practice Address - Phone:813-350-7244
Practice Address - Fax:813-350-7246
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC176958367500000X
VA0024168116367500000X
FLARNP9370840367500000X
TX1094585367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
12367790OtherCAQH
NC8052135Medicaid
NCP00272494OtherRAILROAD-MEDICARE
NC8052135Medicaid