Provider Demographics
NPI:1205470457
Name:GIVARGIDZE, NATALIE (NP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:GIVARGIDZE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 W END AVE
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1539
Mailing Address - Country:US
Mailing Address - Phone:631-942-0258
Mailing Address - Fax:888-261-4649
Practice Address - Street 1:468 W END AVE
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-1539
Practice Address - Country:US
Practice Address - Phone:631-942-0258
Practice Address - Fax:888-261-4649
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031914363LA2200X
NY309335363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health