MEDICARE: NATHALIE ANN POTTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMH26549	FL

General Provider Information

NPI Number	:	1508727066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHALIE ANN POTTS

Provider Business Mailing Address
First Line	:	4504 HUNTERSTON LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-3622
Country	:	US
Telephone Number	:	904-254-0905
Fax Number	:

Provider Business Practice Location Address
First Line	:	3995 HUNT CLUB RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-8416
Country	:	US
Telephone Number	:	904-490-6163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2025
Last Update Date	:	01/19/2026

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