=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528734449
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATALIE RENEE PRINCE APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2021
-----------------------------------------------------
Last Update Date | 06/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1590 FREEDOM BLVD STE B
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29505-6071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-830-0557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3239
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29502-3239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-777-7120
-----------------------------------------------------
Fax | 843-777-7102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 24446
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------