Healthcare Provider Details

I. General information

NPI: 1962995381
Provider Name (Legal Business Name): NATASHA FORNARIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2018
Last Update Date: 06/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 S HIAWASSEE RD APT 123
ORLANDO FL
32835-5785
US

IV. Provider business mailing address

PO BOX 616124
ORLANDO FL
32861-6124
US

V. Phone/Fax

Practice location:
  • Phone: 305-345-1986
  • Fax:
Mailing address:
  • Phone: 305-345-1986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: