Provider Demographics
NPI:1629848288
Name:THAKER, NATASHA (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:THAKER
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 DAHLIA CIR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1463
Mailing Address - Country:US
Mailing Address - Phone:732-589-4885
Mailing Address - Fax:
Practice Address - Street 1:21 AUDUBON AVE # SB0180
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2275
Practice Address - Country:US
Practice Address - Phone:212-932-4537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF353200-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily