Provider Demographics
NPI:1568829521
Name:NATIVIDAD, MONICA (CRNA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:NATIVIDAD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 BELFAST DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1835
Mailing Address - Country:US
Mailing Address - Phone:210-364-7821
Mailing Address - Fax:
Practice Address - Street 1:6104 BELFAST DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-1835
Practice Address - Country:US
Practice Address - Phone:210-364-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129828367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX355247301Medicaid
TX355247302OtherCSHCN
TX355247302OtherCSHCN