Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | ARNP9366533 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | 9366533 | FL |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 9366533 | FL |
NPI | 1639685266 |
---|---|
Provider Name | Ms. Natoya A Queenbourrows |
First Address | Port St Lucie, FL 34986-4343 |
Second Address | West Palm Beach, FL 33407-3114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2017 |
Last Update Date | 08/10/2021 |