Provider Demographics
NPI:1194560698
Name:JOVIN, NATASHA (L-314482)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:JOVIN
Suffix:
Gender:F
Credentials:L-314482
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 GLYNN MARSH CIR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-1851
Mailing Address - Country:US
Mailing Address - Phone:913-579-3180
Mailing Address - Fax:
Practice Address - Street 1:113 GLYNN MARSH CIR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-1851
Practice Address - Country:US
Practice Address - Phone:913-579-3180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAL-314482174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN