Provider Demographics
NPI:1568810299
Name:JIVANI, NATASHA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:
Last Name:JIVANI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11968 THORNBURY VW
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-9016
Mailing Address - Country:US
Mailing Address - Phone:678-462-9576
Mailing Address - Fax:
Practice Address - Street 1:11968 THORNBURY VW
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-9016
Practice Address - Country:US
Practice Address - Phone:678-462-9576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical