Provider Demographics
NPI:1639475130
Name:HOUSTON, NATASHA NICOL (PA)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:NICOL
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1100 PELHAM PKWY S
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1001
Mailing Address - Country:US
Mailing Address - Phone:718-574-1928
Mailing Address - Fax:718-919-2374
Practice Address - Street 1:1149-55 MYRTLE AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-574-1928
Practice Address - Fax:718-919-2374
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2022-01-12
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Provider Licenses
StateLicense IDTaxonomies
NY013988363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant