Healthcare Provider Details

I. General information

NPI: 1851831093
Provider Name (Legal Business Name): NATACHA BEAUGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 SAWGRASS CORPORATE PKWY STE 106
SUNRISE FL
33325-6236
US

IV. Provider business mailing address

5743 KIMBERTON WAY
LAKE WORTH FL
33463-6693
US

V. Phone/Fax

Practice location:
  • Phone: 954-745-1112
  • Fax:
Mailing address:
  • Phone: 561-291-1182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number103TB0200X
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: