Provider Demographics
NPI:1932577236
Name:WILSON, NATASHA (NP)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 RICHARD JONES RD STE 220
Mailing Address - Street 2:GOLD SKIN CARE CENTER
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2885
Mailing Address - Country:US
Mailing Address - Phone:615-383-2400
Mailing Address - Fax:615-383-1948
Practice Address - Street 1:2000 RICHARD JONES RD STE 220
Practice Address - Street 2:GOLD SKIN CARE CENTER
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2885
Practice Address - Country:US
Practice Address - Phone:615-383-2400
Practice Address - Fax:615-383-1948
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21843363LP2300X
WI6617-33363LP2300X
TNAPN0000021843363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI363LP2300XMedicaid
WI363LP2300XMedicare UPIN
WI363LP2300XMedicare PIN
WI363LP2300XMedicaid