Healthcare Provider Details

I. General information

NPI: 1427912252
Provider Name (Legal Business Name): NANCY BOURBONNAIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 SPRING RIDGE DR
DEBARY FL
32713-3725
US

IV. Provider business mailing address

51 SPRING RIDGE DR
DEBARY FL
32713-3725
US

V. Phone/Fax

Practice location:
  • Phone: 407-417-7020
  • Fax: 386-200-1328
Mailing address:
  • Phone: 407-417-7020
  • Fax: 386-200-1328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: