Healthcare Provider Details

I. General information

NPI: 1598454340
Provider Name (Legal Business Name): NATASHA ALEXANDRIA AGUILERA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 S SEACREST BLVD STE 220
BOYNTON BEACH FL
33435-7965
US

IV. Provider business mailing address

5519 N MILITARY TRL APT 1008
BOCA RATON FL
33496-3490
US

V. Phone/Fax

Practice location:
  • Phone: 614-132-8505
  • Fax: 561-509-7102
Mailing address:
  • Phone: 305-998-8629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9117359
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberPA9117359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: