Individual
NATHAN J AMBROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5000 AMBASSADOR CAFFERY PKWY STE A, LAFAYETTE, LA 70508-6984
(337) 470-3580
(337) 470-3586
Mailing address
1132 GATHER DR, LAWRENCEVILLE, GA 30043-7549
(810) 625-4218
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
324792
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058924-PA
CDS
LA
01
—
324792
STATE LICENSE
LA
Enumeration date
08/16/2019
Last updated
03/07/2023
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