Healthcare Provider Details

I. General information

NPI: 1528048568
Provider Name (Legal Business Name): NANCY ANNETTE KONOW LDH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: NANCY ANNETTE GRANT LDH

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15100 RESCUE WAY
CLEARWATER FL
33762-3524
US

IV. Provider business mailing address

103 STRAWBERRY RIDGE BLVD
VALRICO FL
33594-3571
US

V. Phone/Fax

Practice location:
  • Phone: 727-535-1437
  • Fax: 727-535-4190
Mailing address:
  • Phone: 813-685-0735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number13001281A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: