Healthcare Provider Details

I. General information

NPI: 1699304246
Provider Name (Legal Business Name): NANCY SAMIR AWAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 STATE ROAD 54 STE 102
TRINITY FL
34655-2267
US

IV. Provider business mailing address

10900 STATE ROAD 54 STE 102
TRINITY FL
34655-2267
US

V. Phone/Fax

Practice location:
  • Phone: 727-312-4384
  • Fax: 727-312-4605
Mailing address:
  • Phone: 727-312-4384
  • Fax: 727-312-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS60331
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: