Healthcare Provider Details

I. General information

NPI: 1275545097
Provider Name (Legal Business Name): NANCY NUNN GREEN AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY LEE NUNN

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10923 PERCHERDON
JACKSONVILLE FL
32257
US

IV. Provider business mailing address

PO BOX 24536
JACKSONVILLE FL
32241-4536
US

V. Phone/Fax

Practice location:
  • Phone: 904-880-1710
  • Fax: 904-880-1711
Mailing address:
  • Phone: 904-880-1710
  • Fax: 904-880-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: