Provider Demographics
NPI:1073605747
Name:SPENCER, NANCY THERESA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:THERESA
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:THERESA
Other - Last Name:LA MOTTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8430 BELLE MEADE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-6009
Mailing Address - Country:US
Mailing Address - Phone:239-826-7903
Mailing Address - Fax:239-645-4777
Practice Address - Street 1:12791 WORLD PLAZA LN BLDG 89
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3989
Practice Address - Country:US
Practice Address - Phone:239-826-7903
Practice Address - Fax:239-645-4777
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6815103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74129OtherBCBS FL
FLU1838YMedicare UPIN