Provider Demographics
NPI:1164487690
Name:HENKLE-MCPEEK, NANCYE (PT)
Entity Type:Individual
Prefix:
First Name:NANCYE
Middle Name:
Last Name:HENKLE-MCPEEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 NW 76TH DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6652
Mailing Address - Country:US
Mailing Address - Phone:352-331-3161
Mailing Address - Fax:
Practice Address - Street 1:108 NW 76TH DR
Practice Address - Street 2:SUITE A
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-6652
Practice Address - Country:US
Practice Address - Phone:352-331-3161
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11001208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY5106OtherBLUE CROSS BLUE SHIELD
FLY5106ZMedicare ID - Type Unspecified