Healthcare Provider Details

I. General information

NPI: 1962762799
Provider Name (Legal Business Name): NATALIE ETIENNE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2012
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 COUNTY ROAD 17A W
AVON PARK FL
33825-2164
US

IV. Provider business mailing address

47 5TH STREET NW
WINTER HAVEN FL
33881
US

V. Phone/Fax

Practice location:
  • Phone: 863-452-3000
  • Fax: 863-452-3002
Mailing address:
  • Phone: 863-291-5110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9182912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: