Healthcare Provider Details

I. General information

NPI: 1033690318
Provider Name (Legal Business Name): NATASHA HALYARD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ATLANTIC AVE
CAMDEN NJ
08104-1132
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-246-3542
  • Fax: 856-246-3528
Mailing address:
  • Phone: 856-246-3542
  • Fax: 856-246-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00850800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: