Provider Demographics
NPI:1285285619
Name:STEVENSON, NATESHA OCTAVIA (APRN-BC)
Entity type:Individual
Prefix:
First Name:NATESHA
Middle Name:OCTAVIA
Last Name:STEVENSON
Suffix:
Gender:
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 W FAIRBANKS AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4679
Mailing Address - Country:US
Mailing Address - Phone:407-646-7845
Mailing Address - Fax:407-646-7846
Practice Address - Street 1:1573 W FAIRBANKS AVE STE 210
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4679
Practice Address - Country:US
Practice Address - Phone:407-646-7845
Practice Address - Fax:407-646-7846
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003927363LF0000X
FL11003927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily