MEDICARE: LAURIE MAY NANEZ ANDAL D.O.

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	207R00000X	Internal Medicine Physician	013828	PA
2	207RN0300X	Nephrology Physician	OS13321	FL

General Provider Information

NPI Number	:	1548573843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE MAY NANEZ ANDAL D.O.

Provider Business Mailing Address
First Line	:	1935 WORTH CT
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34211-2110
Country	:	US
Telephone Number	:	941-251-4031
Fax Number	:	941-251-4034

Provider Business Practice Location Address
First Line	:	1935 WORTH CT
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34211-2110
Country	:	US
Telephone Number	:	941-251-4031
Fax Number	:	941-251-4034

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

Provider Enumeration Date	:	07/15/2010
Last Update Date	:	02/26/2024

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