Provider Demographics
NPI:1295598068
Name:GALLON, NATASHA RENE (FNP-BC)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:RENE
Last Name:GALLON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SPRINGDALE WAY
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2258
Mailing Address - Country:US
Mailing Address - Phone:305-300-0354
Mailing Address - Fax:
Practice Address - Street 1:5838 HARBOUR VIEW BLVD STE 240
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2663
Practice Address - Country:US
Practice Address - Phone:757-483-3030
Practice Address - Fax:757-484-7239
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily