Healthcare Provider Details

I. General information

NPI: 1407772866
Provider Name (Legal Business Name): NATALIE WELLS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALIE MIKOLSKY/GOMMEL

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17721 BALI GROVE LOOP APT 413
WINTER GARDEN FL
34787-7758
US

IV. Provider business mailing address

17721 BALI GROVE LOOP APT 413
WINTER GARDEN FL
34787-7758
US

V. Phone/Fax

Practice location:
  • Phone: 440-478-6405
  • Fax:
Mailing address:
  • Phone: 440-478-6405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF408330-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: