Healthcare Provider Details

I. General information

NPI: 1649983552
Provider Name (Legal Business Name): NANCY ANN REDMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 MOSELEY AVE
PALATKA FL
32177-4937
US

IV. Provider business mailing address

1253 N GRANDVIEW AVE
DAYTONA BEACH FL
32118-3650
US

V. Phone/Fax

Practice location:
  • Phone: 386-562-0170
  • Fax:
Mailing address:
  • Phone: 386-290-3490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0564
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: