Provider Demographics
NPI:1033878574
Name:DAGOBERT, NATHALIE (APRN)
Entity Type:Individual
Prefix:MS
First Name:NATHALIE
Middle Name:
Last Name:DAGOBERT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7653 NW 79TH AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2874
Mailing Address - Country:US
Mailing Address - Phone:954-793-1176
Mailing Address - Fax:
Practice Address - Street 1:505 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4109
Practice Address - Country:US
Practice Address - Phone:954-793-1176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11016932363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health