Provider Demographics
NPI:1699891804
Name:INNOCENT, NATACHA (LPN)
Entity type:Individual
Prefix:MS
First Name:NATACHA
Middle Name:
Last Name:INNOCENT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2066 SW 153RD WAY
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4376
Mailing Address - Country:US
Mailing Address - Phone:786-285-1854
Mailing Address - Fax:
Practice Address - Street 1:3727 SE OCEAN BLVD
Practice Address - Street 2:200-B
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-6740
Practice Address - Country:US
Practice Address - Phone:800-355-1201
Practice Address - Fax:772-781-7271
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5175887164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse