Provider Demographics
NPI:1013676030
Name:GOLDEN, NATALIA
Entity Type:Individual
Prefix:MRS
First Name:NATALIA
Middle Name:
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 KERRY FOREST PKWY # D4328
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-6892
Mailing Address - Country:US
Mailing Address - Phone:850-329-0833
Mailing Address - Fax:850-999-7123
Practice Address - Street 1:3653 CAGNEY DR STE 205
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-3353
Practice Address - Country:US
Practice Address - Phone:850-800-6023
Practice Address - Fax:850-999-7123
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL237440253Z00000X
261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021085100Medicaid