Provider Demographics
NPI:1306179932
Name:FLOYD, BAMBIE NICOLE (APRN)
Entity Type:Individual
Prefix:
First Name:BAMBIE
Middle Name:NICOLE
Last Name:FLOYD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3028
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3028
Mailing Address - Country:US
Mailing Address - Phone:843-230-6701
Mailing Address - Fax:
Practice Address - Street 1:805 PAMPLICO HWY STE 320
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6019
Practice Address - Country:US
Practice Address - Phone:843-629-2605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily