Provider Demographics
NPI:1760121453
Name:ANTAYA, NATALIE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:MARIE
Last Name:ANTAYA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000 LBX 7650
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:791 TURNER ST UNIT 2
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6314
Practice Address - Country:US
Practice Address - Phone:207-330-3900
Practice Address - Fax:207-330-3940
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-01
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant