Provider Demographics
NPI:1669914453
Name:DESANTIS, NATALIE SUZANNE (APRN)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:SUZANNE
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21942 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9723
Mailing Address - Country:US
Mailing Address - Phone:941-505-2100
Mailing Address - Fax:
Practice Address - Street 1:21942 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9723
Practice Address - Country:US
Practice Address - Phone:941-505-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9238710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDS5131OtherRR MEDICARE GROUP
FL003XXOtherBC/BS GROUP
FLIW096ZMedicare UPIN
FL003XXOtherBC/BS GROUP