Provider Demographics
NPI:1982327896
Name:KING, NATASHA SANDRIA (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:NATASHA
Middle Name:SANDRIA
Last Name:KING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12043 JAPANESE MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-1562
Mailing Address - Country:US
Mailing Address - Phone:904-472-7853
Mailing Address - Fax:
Practice Address - Street 1:1697 KINGS RD STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6169
Practice Address - Country:US
Practice Address - Phone:904-478-5483
Practice Address - Fax:833-918-2285
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11021727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily