Provider Demographics
NPI:1154323400
Name:LOBBY, NANCY JEAN (DO)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEAN
Last Name:LOBBY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10115 FOREST HILL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6178
Mailing Address - Country:US
Mailing Address - Phone:561-795-1234
Mailing Address - Fax:561-800-1006
Practice Address - Street 1:10115 FOREST HILL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6178
Practice Address - Country:US
Practice Address - Phone:561-795-1234
Practice Address - Fax:561-800-1006
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8529208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78633OtherBC/BS FLORIDA
FL78633OtherBC/BS FLORIDA
E8676Medicare ID - Type Unspecified