Provider Demographics
NPI:1386645059
Name:KLIBANOFF, NANCY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:
Last Name:KLIBANOFF
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 S PINELLAS AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3719
Mailing Address - Country:US
Mailing Address - Phone:727-938-1908
Mailing Address - Fax:727-938-8693
Practice Address - Street 1:1259 S PINELLAS AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3719
Practice Address - Country:US
Practice Address - Phone:727-938-1908
Practice Address - Fax:727-938-8693
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN742152363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL24428Medicare ID - Type UnspecifiedGROUP
FLY4757ZMedicare ID - Type Unspecified
FLR88090Medicare UPIN