Provider Demographics
NPI:1891778262
Name:HERTZ, NATALIA GOETZ (BCFNP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIA
Middle Name:GOETZ
Last Name:HERTZ
Suffix:
Gender:F
Credentials:BCFNP
Other - Prefix:MS
Other - First Name:NATALIA
Other - Middle Name:
Other - Last Name:GOETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:
Practice Address - Street 1:724 AUBREY BELL DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5055
Practice Address - Country:US
Practice Address - Phone:704-295-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166742363LF0000X
NC0050-03620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01309686OtherMEDICARE RAILROAD
SC30159536OtherSELECT HEALTH
NC7005152Medicaid
SC1046727OtherWELLCARE OF SC
7364986OtherAETNA
NC17812OtherBCBSNC
SCNP1396Medicaid
NC7005152Medicaid
SCNP1396Medicaid