1386918944 NPI number — MS. NATALIE LYNN SWEETING M.S

Table of content: MS. NATALIE LYNN SWEETING M.S (NPI 1386918944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386918944 NPI number — MS. NATALIE LYNN SWEETING M.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEETING
Provider First Name:
NATALIE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386918944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1503 UNITED ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEY WEST
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33040-3519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-395-2343
Provider Business Mailing Address Fax Number:
305-768-0803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5030 5TH AVE
Provider Second Line Business Practice Location Address:
UNIT 73
Provider Business Practice Location Address City Name:
KEY WEST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33040-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-395-2343
Provider Business Practice Location Address Fax Number:
305-768-0803
Provider Enumeration Date:
02/29/2012

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004648200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106854000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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