Healthcare Provider Details

I. General information

NPI: 1265411706
Provider Name (Legal Business Name): NATHANIEL MICHAEL APATOV CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 INDEPENDENCE BLVD STE 2G
VIRGINIA BEACH VA
23455-6010
US

IV. Provider business mailing address

816 INDEPENDENCE BLVD STE 2G
VIRGINIA BEACH VA
23455-6010
US

V. Phone/Fax

Practice location:
  • Phone: 757-363-6728
  • Fax: 757-363-6204
Mailing address:
  • Phone: 757-363-6728
  • Fax: 757-363-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-54599
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024164170
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: