Healthcare Provider Details

I. General information

NPI: 1790898690
Provider Name (Legal Business Name): NANCY J VANCE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NANCY J ANTONACCI

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 5TH AVE S SUITE 104
NAPLES FL
34102-3492
US

IV. Provider business mailing address

4888 DAVIS BLVD #290
NAPLES FL
34104-5338
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-0074
  • Fax: 239-261-0141
Mailing address:
  • Phone: 859-948-5422
  • Fax: 239-261-0141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License NumberME106180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: