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General NPI Number Information
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NPI Number | 1679325385
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Entity Type | Individual
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Provider Name | NATASSIA MONIQUE WALBURG AGPCNP-BC, APRN, MSN
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Gender | Female
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Dates
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Enumeration Date | 04/04/2024
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 201 N CLYDE MORRIS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2724
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Country | US
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Telephone | 386-425-4787
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Fax |
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Provider Business Mailing Address
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Address Line | 27 MEADOW RIDGE VW
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City | ORMOND BEACH
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State | FL
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Zip | 32174-2405
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Country | US
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Telephone | 386-295-3365
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11032018
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN11032018
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License Number State | FL
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