Provider Demographics
NPI:1407456064
Name:ETIENNE, NATACHA (FNP)
Entity Type:Individual
Prefix:
First Name:NATACHA
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NA
Other - Middle Name:
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:2379 NW 33RD TER
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2253
Mailing Address - Country:US
Mailing Address - Phone:156-176-8322
Mailing Address - Fax:
Practice Address - Street 1:5300 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4395
Practice Address - Country:US
Practice Address - Phone:561-768-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9346858363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily