Provider Demographics
NPI:1811663347
Name:MILLER, NATASHA ANN (AGPCNP)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 N HAYWORTH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5215
Mailing Address - Country:US
Mailing Address - Phone:502-641-3791
Mailing Address - Fax:
Practice Address - Street 1:1226 N HAYWORTH AVE APT 1
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5215
Practice Address - Country:US
Practice Address - Phone:502-641-3791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018106363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care