Provider Demographics
NPI:1316438682
Name:NICOLAS, NATASHA N/A (RN)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:N/A
Last Name:NICOLAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 RIDGEMONT RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-2340
Mailing Address - Country:US
Mailing Address - Phone:407-350-0775
Mailing Address - Fax:
Practice Address - Street 1:3809 RIDGEMONT RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-2340
Practice Address - Country:US
Practice Address - Phone:407-350-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9482937163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse