Healthcare Provider Details

I. General information

NPI: 1891960183
Provider Name (Legal Business Name): NANCY K BELLARD L.AC., A,P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SEAGROVE MAIN STREET
SAINT AUGUSTINE FL
32080-6088
US

IV. Provider business mailing address

120 SEAGROVE MAIN STREET
ST. AUGUSTINE FL
32080-6088
US

V. Phone/Fax

Practice location:
  • Phone: 904-671-2860
  • Fax:
Mailing address:
  • Phone: 904-671-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: