=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952600975
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY ELLEN FLOREY ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2011
-----------------------------------------------------
Last Update Date | 02/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4266 SUNBEAM RD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32257-2425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-407-5109
-----------------------------------------------------
Fax | 904-407-6007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 832 LINCOLN RD
-----------------------------------------------------
City | NEPTUNE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32266-3726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-626-9637
-----------------------------------------------------
Fax | 904-407-8124
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | ARNP2676682
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN2676682
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------