Provider Demographics
NPI:1023412301
Name:OSTLER, NATHAN (FNP-C)
Entity type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:OSTLER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4049 E HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3281
Mailing Address - Country:US
Mailing Address - Phone:480-939-3409
Mailing Address - Fax:703-634-7483
Practice Address - Street 1:4111 E AUTO VALLEY DRIVE
Practice Address - Street 2:209-4
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-939-3409
Practice Address - Fax:703-634-7483
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ960757Medicaid
AZ960757Medicaid