Healthcare Provider Details

I. General information

NPI: 1457114159
Provider Name (Legal Business Name): NATALIA SERRANO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 WILKINSON BLVD
CHARLOTTE NC
28208-5631
US

IV. Provider business mailing address

3333 WILKINSON BLVD
CHARLOTTE NC
28208-5631
US

V. Phone/Fax

Practice location:
  • Phone: 866-299-4968
  • Fax:
Mailing address:
  • Phone: 866-299-4968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number14908
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number031554
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: