1275076762 NPI number — NATASHA ANN-MARIE KARGBO APRN, FNP-C

Table of content: NATASHA ANN-MARIE KARGBO APRN, FNP-C (NPI 1275076762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275076762 NPI number — NATASHA ANN-MARIE KARGBO APRN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARGBO
Provider First Name:
NATASHA
Provider Middle Name:
ANN-MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SANGSTER
Provider Other First Name:
NATASHA
Provider Other Middle Name:
ANN-MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APN,MSN-ED,BSN,RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275076762
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 LIPPINCOTT DR STE 410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08053-4197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-355-0340
Provider Business Mailing Address Fax Number:
856-355-0330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 BOWMAN DR
Provider Second Line Business Practice Location Address:
VIRTUA VOORHEES, 1ST FLOOR
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-9612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-247-2594
Provider Business Practice Location Address Fax Number:
856-247-2597
Provider Enumeration Date:
12/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  26NJ00679800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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