Healthcare Provider Details

I. General information

NPI: 1699654319
Provider Name (Legal Business Name): NATHALIE CORDOVA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SE 3RD AVE STE 502
FORT LAUDERDALE FL
33316-2521
US

IV. Provider business mailing address

1625 SE 3RD AVE STE 502
FORT LAUDERDALE FL
33316-2521
US

V. Phone/Fax

Practice location:
  • Phone: 954-581-8706
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number11040376
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: