MEDICARE: DR. NANCY ELLEN BOUCHARD DDS

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	1223G0001X	General Practice Dentistry	21427	FL
2	1223G0001X	General Practice Dentistry	13753	MD

General Provider Information

NPI Number	:	1548342413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY ELLEN BOUCHARD DDS

Provider Business Mailing Address
First Line	:	13611 MCGREGOR BLVD STE 3
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-6042
Country	:	US
Telephone Number	:	239-463-5433
Fax Number	:

Provider Business Practice Location Address
First Line	:	13611 MCGREGOR BLVD STE 3
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-6042
Country	:	US
Telephone Number	:	239-463-5433
Fax Number	:

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	06/17/2026

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