Provider Demographics
NPI:1104397512
Name:NIEVES, NANCY (FNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 THONOTOSASSA RD STE A
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563-4202
Mailing Address - Country:US
Mailing Address - Phone:813-567-5679
Mailing Address - Fax:813-567-5686
Practice Address - Street 1:1703 THONOTOSASSA RD STE A
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4202
Practice Address - Country:US
Practice Address - Phone:813-567-5679
Practice Address - Fax:813-567-5686
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily