Healthcare Provider Details

I. General information

NPI: 1154472330
Provider Name (Legal Business Name): NANCY PERKINS GROSSMAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 W DOUBLE EAGLE CT
HERNANDO FL
34442-6240
US

IV. Provider business mailing address

1390 W DOUBLE EAGLE CT
HERNANDO FL
34442-6240
US

V. Phone/Fax

Practice location:
  • Phone: 352-746-1776
  • Fax:
Mailing address:
  • Phone: 352-746-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MB04084200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: