Individual provider Active NPI

Nataccia Henry

  • Acute Care Nurse Practitioner
  • Cutler Bay, FL
National Provider Identifier
1720693450
Registry record updated Sep 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
11008136 Issued in FL
Practice address
21929 SW 93Rd PL
Cutler Bay, FL 33190-1231
Phone
(786) 762-6931
NPI assigned
Sep 10, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 18, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 11008136 FL Primary

Addresses

Primary practice location

21929 SW 93Rd PL
Cutler Bay, FL 33190-1231

Mailing address

21929 SW 93Rd PL
Cutler Bay, FL 33190-1231
Phone (786) 762-6931

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201214000557 FL Practitioner - Nurse Practitioner 5890107031 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Broward Hospital DistrictGroup PAC ID 8123927373, 659 clinicians

Practice addresses (Care Compare)

601 N Flamingo Rd
Suite 206
Pembroke Pines, FL 33028-1009
Phone (954) 844-6825

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
11008136FLMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Broward Hospital District Current Accepting new patients
South Broward Hospital District CurrentSince Nov 20, 2023 Accepting new patients
South Broward Hospital District CurrentSince Nov 20, 2023 Accepting new patients
South Broward Hospital District Past Accepting new patients

Locations

1150 N 35th Ave
Ste 300
Hollywood, FL 33021
Phone (954) 265-1490

2900 Corporate Way
#D
Miramar, FL 33025
Phone (954) 276-5581

601 N Flamingo Rd
Ste 206
Pembroke Pnes, FL 33028
Phone (954) 844-6825

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600387200000",
    "number": "1720693450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21929 SW 93RD PL",
            "city": "CUTLER BAY",
            "state": "FL",
            "postal_code": "331901231",
            "telephone_number": "786-762-6931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21929 SW 93RD PL",
            "city": "CUTLER BAY",
            "state": "FL",
            "postal_code": "331901231",
            "telephone_number": "786-762-6931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "NATACCIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-10",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "11008136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cutler Bay, FL

Sources for this page

Verify at the official NPI Registry.