Provider Demographics
NPI:1780454819
Name:ROLLINS, NATASHA (NP)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:35318 EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60678-1353
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1400 OTTO BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3871
Practice Address - Country:US
Practice Address - Phone:708-733-7200
Practice Address - Fax:708-733-7222
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209029028363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner