Provider Demographics
NPI:1124393988
Name:SYPOLT, NANCY (RNFA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SYPOLT
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-8271
Mailing Address - Country:US
Mailing Address - Phone:386-274-5712
Mailing Address - Fax:386-274-1926
Practice Address - Street 1:2460 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-8271
Practice Address - Country:US
Practice Address - Phone:386-274-5712
Practice Address - Fax:386-274-1926
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9179484163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant