Provider Demographics
NPI:1699452052
Name:MOURE, NATALIE CALVO (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:CALVO
Last Name:MOURE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 MEADOW WALK LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8074
Mailing Address - Country:US
Mailing Address - Phone:786-683-2634
Mailing Address - Fax:
Practice Address - Street 1:4375 SOUTHSIDE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5494
Practice Address - Country:US
Practice Address - Phone:866-465-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily