Provider Demographics
NPI:1124234018
Name:MADDOX, NATALIE R (DOM, AP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:R
Last Name:MADDOX
Suffix:
Gender:F
Credentials:DOM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S OBRIEN ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2409
Mailing Address - Country:US
Mailing Address - Phone:813-758-3427
Mailing Address - Fax:
Practice Address - Street 1:1310 S HOWARD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3125
Practice Address - Country:US
Practice Address - Phone:813-758-3427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2208171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist