Healthcare Provider Details

I. General information

NPI: 1770149106
Provider Name (Legal Business Name): NANCY CARSON DENNIS RN BSN CCRN-CSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

907 SW 11TH AVE
FORT LAUDERDALE FL
33315-1136
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-2000
  • Fax:
Mailing address:
  • Phone: 954-683-5931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9371076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: