Provider Demographics
NPI:1437490190
Name:VERNON, NATASHA (FNP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:VERNON
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 1:1303 LIMIT AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-3135
Mailing Address - Country:US
Mailing Address - Phone:407-694-7286
Mailing Address - Fax:
Practice Address - Street 1:1303 LIMIT AVE STE 207
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-3135
Practice Address - Country:US
Practice Address - Phone:352-405-0078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9305774163WP0808X
FLAPRN9305774163WP0809X
FLARNP9305774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult