Provider Demographics
NPI:1952498941
Name:AMBROISE, NATACHA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NATACHA
Middle Name:
Last Name:AMBROISE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16211 SW 49TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4944
Mailing Address - Country:US
Mailing Address - Phone:954-435-4178
Mailing Address - Fax:
Practice Address - Street 1:15859 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1220
Practice Address - Country:US
Practice Address - Phone:954-443-2149
Practice Address - Fax:954-443-2150
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1085023OtherNABP
FL1085023OtherNABP