Provider Demographics
NPI:1518308147
Name:MATIAS, NATARA (FNP)
Entity type:Individual
Prefix:
First Name:NATARA
Middle Name:
Last Name:MATIAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 HOLLAND AVE APT 4H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2974
Mailing Address - Country:US
Mailing Address - Phone:812-227-5937
Mailing Address - Fax:
Practice Address - Street 1:1820 AVENUE M # 968
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5347
Practice Address - Country:US
Practice Address - Phone:812-227-5937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342236363LF0000X
NY639451163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse