Provider Demographics
NPI:1285134429
Name:MENDEZ, NATACHA (APRN)
Entity type:Individual
Prefix:
First Name:NATACHA
Middle Name:
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:954-486-8020
Mailing Address - Fax:954-486-8983
Practice Address - Street 1:4400 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5862
Practice Address - Country:US
Practice Address - Phone:954-486-8020
Practice Address - Fax:954-486-8983
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9310276363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102823000Medicaid