Healthcare Provider Details

I. General information

NPI: 1497125942
Provider Name (Legal Business Name): NANCY NATALIE FONG-EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2015
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CLEMATIS ST RM 5531
WEST PALM BEACH FL
33401-5107
US

IV. Provider business mailing address

8645 N MILITARY TRL STE 508
WEST PALM BEACH FL
33410-6296
US

V. Phone/Fax

Practice location:
  • Phone: 561-671-4043
  • Fax:
Mailing address:
  • Phone: 561-630-8001
  • Fax: 561-630-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9327531
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: