Healthcare Provider Details

I. General information

NPI: 1033878574
Provider Name (Legal Business Name): NATHALIE DAGOBERT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 N UNIVERSITY DR STE 210
TAMARAC FL
33321-1700
US

IV. Provider business mailing address

7653 NW 79TH AVE APT 208
TAMARAC FL
33321-2874
US

V. Phone/Fax

Practice location:
  • Phone: 954-793-1176
  • Fax:
Mailing address:
  • Phone: 954-793-1176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95033789
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11016932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: