Healthcare Provider Details

I. General information

NPI: 1720129158
Provider Name (Legal Business Name): NANCY KAY FERGUS L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 A1A S SUITE 100
ST AUGUSTINE FL
32080-6591
US

IV. Provider business mailing address

1017 ARAGON AVE
ST AUGUSTINE FL
32086-7047
US

V. Phone/Fax

Practice location:
  • Phone: 904-669-3953
  • Fax: 904-471-6236
Mailing address:
  • Phone: 904-797-0273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA 30970
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: