Provider Demographics
NPI:1144836677
Name:CLINE, NATASHA JAEL (FNP-C)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:JAEL
Last Name:CLINE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 GRIFFIN POND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ABINGTON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18411-8829
Mailing Address - Country:US
Mailing Address - Phone:304-673-8999
Mailing Address - Fax:
Practice Address - Street 1:105 LAYTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH ABINGTON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18411-9376
Practice Address - Country:US
Practice Address - Phone:570-586-8186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP022490OtherSTATE CRNP LICENSE