Provider Demographics
NPI:1407136435
Name:DEGROFF, NATALIE SCALISE (FNP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:SCALISE
Last Name:DEGROFF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 HIGHLAND COLONY PKWY
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-6076
Mailing Address - Country:US
Mailing Address - Phone:877-443-4006
Mailing Address - Fax:888-298-2220
Practice Address - Street 1:623 HIGHLAND COLONY PKWY
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157
Practice Address - Country:US
Practice Address - Phone:720-290-4071
Practice Address - Fax:601-510-7694
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO175562163W00000X
AZAP4123363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse