Healthcare Provider Details

I. General information

NPI: 1205470457
Provider Name (Legal Business Name): NATALIE GIVARGIDZE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 W END AVE
SHIRLEY NY
11967-1539
US

IV. Provider business mailing address

468 W END AVE
SHIRLEY NY
11967-1539
US

V. Phone/Fax

Practice location:
  • Phone: 631-942-0258
  • Fax: 888-261-4649
Mailing address:
  • Phone: 631-942-0258
  • Fax: 888-261-4649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11031914
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number309335
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: