Healthcare Provider Details

I. General information

NPI: 1780679589
Provider Name (Legal Business Name): NANCY M WORTHINGTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2005
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

5528 NW 43RD ST
GAINESVILLE FL
32653-3301
US

V. Phone/Fax

Practice location:
  • Phone: 352-371-3604
  • Fax: 352-371-4865
Mailing address:
  • Phone: 352-371-3604
  • Fax: 352-371-4865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME55647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: