Provider Demographics
NPI:1598442071
Name:SMITH, NATASHA (MA)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:SMITH
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-1573
Mailing Address - Country:US
Mailing Address - Phone:850-481-5380
Mailing Address - Fax:
Practice Address - Street 1:2428 JENKS AVE STE B
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4304
Practice Address - Country:US
Practice Address - Phone:850-215-8397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL102897225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist