Provider Demographics
NPI:1962995381
Name:FORNARIS, NATASHA
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:FORNARIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 616124
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-6124
Mailing Address - Country:US
Mailing Address - Phone:305-345-1986
Mailing Address - Fax:
Practice Address - Street 1:1338 S HIAWASSEE RD APT 123
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5785
Practice Address - Country:US
Practice Address - Phone:305-345-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities