Provider Demographics
NPI:1578083473
Name:GROSS, NATASHA KATRINA
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:KATRINA
Last Name:GROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:KATRINA
Other - Last Name:GROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:90 PAYNE ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-5430
Mailing Address - Country:US
Mailing Address - Phone:850-241-6007
Mailing Address - Fax:850-421-1140
Practice Address - Street 1:90 PAYNE STREET
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327
Practice Address - Country:US
Practice Address - Phone:850-241-6007
Practice Address - Fax:850-421-1140
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372600000X, 376J00000X, 374U00000X, 347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020530500Medicaid