Provider Demographics
NPI:1164978920
Name:BROADNAX, NATASHIA (PMHNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:NATASHIA
Middle Name:
Last Name:BROADNAX
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CLIFFVIEW CT
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-6900
Mailing Address - Country:US
Mailing Address - Phone:336-383-9988
Mailing Address - Fax:
Practice Address - Street 1:952 GOLF HOUSE RD W STE INA
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-9286
Practice Address - Country:US
Practice Address - Phone:336-383-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008817363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily