Provider Demographics
NPI:1689155194
Name:JOLIVETTE, NATASHA (NP)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:JOLIVETTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 OAK VILLAGE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-7952
Mailing Address - Country:US
Mailing Address - Phone:682-321-7007
Mailing Address - Fax:682-321-7036
Practice Address - Street 1:1720 OAK VILLAGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-7952
Practice Address - Country:US
Practice Address - Phone:682-321-7007
Practice Address - Fax:682-321-7036
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX862499363LF0000X
TXAP137583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3923229-03Medicaid