Healthcare Provider Details

I. General information

NPI: 1588933782
Provider Name (Legal Business Name): NATSUKO OKAMURA MSN, ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 S WICKHAM RD STE 101
WEST MELBOURNE FL
32904-1647
US

IV. Provider business mailing address

948 S WICKHAM RD STE 101
WEST MELBOURNE FL
32904-1647
US

V. Phone/Fax

Practice location:
  • Phone: 321-608-4946
  • Fax: 321-327-5746
Mailing address:
  • Phone:
  • Fax: 321-327-5746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9250858
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: