Healthcare Provider Details

I. General information

NPI: 1922179274
Provider Name (Legal Business Name): NANCY M. WORTHINGTON, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5528 NW 43RD ST
GAINESVILLE FL
32653-3301
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 Number
License Number State

VIII. Authorized Official

Name: DR. NANCY M WORTHINGTON
Title or Position: OWNER
Credential: MD
Phone: 352-371-3604