Provider Demographics
NPI:1699046151
Name:STACCHINI, NATALIE YOLANDA (RNFA)
Entity Type:Individual
Prefix:MS
First Name:NATALIE
Middle Name:YOLANDA
Last Name:STACCHINI
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N EVERGREEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:LONGPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08403-1414
Mailing Address - Country:US
Mailing Address - Phone:267-884-3175
Mailing Address - Fax:
Practice Address - Street 1:102 N EVERGREEN AVENUE
Practice Address - Street 2:
Practice Address - City:LONGPORT
Practice Address - State:NJ
Practice Address - Zip Code:08403
Practice Address - Country:US
Practice Address - Phone:267-884-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-14
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO07426500364SP2800X
PA249585L364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative