Provider Demographics
NPI:1598454340
Name:AGUILERA, NATASHA ALEXANDRIA (PA-C)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:ALEXANDRIA
Last Name:AGUILERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5519 N MILITARY TRL APT 1008
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3490
Mailing Address - Country:US
Mailing Address - Phone:305-998-8629
Mailing Address - Fax:
Practice Address - Street 1:2800 S SEACREST BLVD STE 220
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7965
Practice Address - Country:US
Practice Address - Phone:614-132-8505
Practice Address - Fax:561-509-7102
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9117359207V00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty