Provider Demographics
NPI:1124161559
Name:VAILLANCOURT, NATESHA ANNE (APRN, CNM)
Entity type:Individual
Prefix:MISS
First Name:NATESHA
Middle Name:ANNE
Last Name:VAILLANCOURT
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
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Mailing Address - Street 1:2230 SW 19TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1391
Mailing Address - Country:US
Mailing Address - Phone:352-368-1360
Mailing Address - Fax:352-237-7728
Practice Address - Street 1:2135 SW 19TH AVENUE RD STE 103
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7877
Practice Address - Country:US
Practice Address - Phone:352-368-1360
Practice Address - Fax:352-237-7728
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9225398367A00000X
FLARNP 9225398367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3079830 00Medicaid