Provider Demographics
NPI:1255901799
Name:ROBERTS, NATALIA MARISSA (FNP)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:MARISSA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NATALIA
Other - Middle Name:MARISSA
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:51 PELLERIA DR
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1432
Mailing Address - Country:US
Mailing Address - Phone:510-861-9063
Mailing Address - Fax:
Practice Address - Street 1:2720 LOW CT
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-9771
Practice Address - Country:US
Practice Address - Phone:707-427-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95209937163W00000X
CANP95017170363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse