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1679325385 NPI number — NATASSIA MONIQUE WALBURG AGPCNP-BC, APRN, MSN

NPI Number: 1679325385
Health Care Provider/Practitioner: NATASSIA MONIQUE WALBURG AGPCNP-BC, APRN, MSN

Information about “1679325385” NPI (NATASSIA MONIQUE WALBURG AGPCNP-BC, APRN, MSN) exists in 1679325385 in HTML format HTML  |  1679325385 in plain Text format TXT  |  1679325385 in PDF (Portable Document Format) PDF  |  1679325385 in an XML format XML  formats.

NPI Number : 1679325385 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679325385",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALBURG",
    "FirstName": "NATASSIA",
    "MiddleName": "MONIQUE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "AGPCNP-BC, APRN, MSN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "27 MEADOW RIDGE VW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ORMOND BEACH",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32174-2405",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "386-295-3365",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "201 N CLYDE MORRIS BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAYTONA BEACH",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32114-2724",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "386-425-4787",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/04/2024",
    "LastUpdateDate": "05/01/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "11032018",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LG0600X",
          "TaxonomyName": "Gerontology Nurse Practitioner",
          "LicenseNumber": "APRN11032018",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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