Provider Demographics
NPI:1679325385
Name:WALBURG, NATASSIA MONIQUE (AGPCNP-BC, APRN, MSN)
Entity type:Individual
Prefix:
First Name:NATASSIA
Middle Name:MONIQUE
Last Name:WALBURG
Suffix:
Gender:F
Credentials:AGPCNP-BC, APRN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MEADOW RIDGE VW
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-2405
Mailing Address - Country:US
Mailing Address - Phone:386-295-3365
Mailing Address - Fax:
Practice Address - Street 1:201 N CLYDE MORRIS BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2724
Practice Address - Country:US
Practice Address - Phone:386-425-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11032018363LF0000X
FLAPRN11032018363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily