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General NPI Number Information
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NPI Number | 1306846829
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Entity Type | Organization
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Legal Business Name | GEORGE NACKLEY MD PL
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Dates
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Enumeration Date | 07/27/2005
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 2380 HARBOR BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-5024
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Country | US
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Telephone | 941-627-1889
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Fax | 941-627-9950
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Provider Business Mailing Address
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Address Line | PO BOX 380639
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City | MURDOCK
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State | FL
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Zip | 33938-0639
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Country | US
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Telephone | 941-627-1889
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Fax | 941-627-9950
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | GEORGE NACKLEY
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Credential | MD
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Telephone | 941-627-1889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | FL
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