=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255001665
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VANESSA NANK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2021
-----------------------------------------------------
Last Update Date | 09/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 303 NE 3RD AVE STE 7&8
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33909-2538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-354-7227
-----------------------------------------------------
Fax | 800-948-3094
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 NE 3RD AVE STE 7&8
-----------------------------------------------------
City | CAPE CORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33909-2538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-354-7227
-----------------------------------------------------
Fax | 800-948-3094
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | SS1548
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------