MEDICARE: JAMES EDWARD NANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1275665697
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES EDWARD NANCE

Provider Business Mailing Address
First Line	:	2654 ISLAND DR
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33023-4604
Country	:	US
Telephone Number	:	954-986-6871
Fax Number	:

Provider Business Practice Location Address
First Line	:	4720 N. STATE RD.7
Second Line	:	BLDG B
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33319
Country	:	US
Telephone Number	:	954-497-3856
Fax Number	:	954-497-3857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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