Healthcare Provider Details

I. General information

NPI: 1639775034
Provider Name (Legal Business Name): NANCI A DAVID FLORES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 SE 1ST AVE
FT LAUDERDALE FL
33316-2875
US

IV. Provider business mailing address

1848 SE 1ST AVE
FT LAUDERDALE FL
33316-2875
US

V. Phone/Fax

Practice location:
  • Phone: 954-885-9500
  • Fax: 954-885-9444
Mailing address:
  • Phone: 954-885-9500
  • Fax: 954-885-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16973
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: