Provider Demographics
NPI:1952499287
Name:EISENHUT, NATALIE K (NP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:K
Last Name:EISENHUT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:K
Other - Last Name:MATHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4721 HIDDEN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-7477
Mailing Address - Country:US
Mailing Address - Phone:386-252-8051
Mailing Address - Fax:
Practice Address - Street 1:1040 W INTERNATIONAL SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-3434
Practice Address - Country:US
Practice Address - Phone:386-252-8051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9231517363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P21154Medicare UPIN