Provider Demographics
NPI:1316917347
Name:WILGOREN, NATALIE (ARNP)
Entity type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:
Last Name:WILGOREN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 COACH HOUSE CIR
Mailing Address - Street 2:D
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-8653
Mailing Address - Country:US
Mailing Address - Phone:561-504-0455
Mailing Address - Fax:561-417-4939
Practice Address - Street 1:72 NE 5TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5427
Practice Address - Country:US
Practice Address - Phone:561-504-0455
Practice Address - Fax:561-272-6204
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2945742363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health