Healthcare Provider Details

I. General information

NPI: 1699172205
Provider Name (Legal Business Name): NATALIE ANNE STECKO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE ANNE KACZMAR-STECKO PA-C

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 12/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 NW 87TH AVE UNIT 7
DORAL FL
33172-1603
US

IV. Provider business mailing address

2363 NW 162ND TER
PEMBROKE PINES FL
33028-1703
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-5155
  • Fax: 305-653-5513
Mailing address:
  • Phone: 248-622-3813
  • Fax: 305-653-5513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMPA2241
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9109126
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: