Provider Demographics
NPI:1154472330
Name:GROSSMAN, NANCY PERKINS (DO)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:PERKINS
Last Name:GROSSMAN
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 1:1390 W DOUBLE EAGLE CT
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-6240
Mailing Address - Country:US
Mailing Address - Phone:352-746-1776
Mailing Address - Fax:
Practice Address - Street 1:1390 W DOUBLE EAGLE CT
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-6240
Practice Address - Country:US
Practice Address - Phone:352-746-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB040842002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry