Healthcare Provider Details

I. General information

NPI: 1730025123
Provider Name (Legal Business Name): NORTHERN STAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5265 UNIVERSITY PKWY # 101-189
UNIVERSITY PARK FL
34201-3012
US

IV. Provider business mailing address

5265 UNIVERSITY PKWY # 101-189
UNIVERSITY PARK FL
34201-3012
US

V. Phone/Fax

Practice location:
  • Phone: 703-717-1753
  • Fax:
Mailing address:
  • Phone: 703-717-1753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: