Healthcare Provider Details

I. General information

NPI: 1508791526
Provider Name (Legal Business Name): NATECKA SAMANTHA TAYLOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W PRINCETON ST
ORLANDO FL
32804-5214
US

IV. Provider business mailing address

720 W PRINCETON ST
ORLANDO FL
32804-5214
US

V. Phone/Fax

Practice location:
  • Phone: 407-553-8587
  • Fax: 407-537-2063
Mailing address:
  • Phone: 407-553-8587
  • Fax: 407-537-2063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11045993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: