Provider Demographics
NPI:1205300340
Name:HERSPERGER, NATALIE NICOLE
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:NICOLE
Last Name:HERSPERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NATALIE
Other - Middle Name:NICOLE
Other - Last Name:LAMERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:926 N HYER AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3202
Mailing Address - Country:US
Mailing Address - Phone:817-504-2126
Mailing Address - Fax:
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-303-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9436919163W00000X
FLAPRN11003064367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse