Provider Demographics
NPI:1326555715
Name:RAWSON, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:RAWSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CAROLYN AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-5607
Mailing Address - Country:US
Mailing Address - Phone:850-527-3598
Mailing Address - Fax:
Practice Address - Street 1:204 CAROLYN AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-5607
Practice Address - Country:US
Practice Address - Phone:850-527-3598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-07
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL247200000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other