Provider Demographics
NPI:1174094874
Name:PURCELL, NANCY CAROL (CAT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:CAROL
Last Name:PURCELL
Suffix:
Gender:F
Credentials:CAT
Other - Prefix:
Other - First Name:CAT
Other - Middle Name:
Other - Last Name:PURCELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2945 PINE TREE DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-5617
Mailing Address - Country:US
Mailing Address - Phone:954-805-6775
Mailing Address - Fax:386-409-5193
Practice Address - Street 1:2945 PINE TREE DR
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141-5617
Practice Address - Country:US
Practice Address - Phone:954-805-6775
Practice Address - Fax:386-409-5193
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103T00000XBehavioral Health & Social Service ProvidersPsychologist