Healthcare Provider Details

I. General information

NPI: 1578083473
Provider Name (Legal Business Name): NATASHA KATRINA GROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATASHA KATRINA GROSS

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/26/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 PAYNE STREET
CRAWFORDVILLE FL
32327
US

IV. Provider business mailing address

90 PAYNE ST
CRAWFORDVILLE FL
32327-5430
US

V. Phone/Fax

Practice location:
  • Phone: 850-241-6007
  • Fax: 850-421-1140
Mailing address:
  • Phone: 850-241-6007
  • Fax: 850-421-1140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: