Provider Demographics
NPI:1407817927
Name:MENDENHALL, NANCY P (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:P
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:MD
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 116304
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6304
Mailing Address - Country:US
Mailing Address - Phone:904-588-1263
Mailing Address - Fax:
Practice Address - Street 1:2015 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-3531
Practice Address - Country:US
Practice Address - Phone:904-588-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME390542085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000415632EMedicaid
FL0686042-00Medicaid
FL920006634OtherRAILROAD MEDICARE
FL068604200Medicaid
FL068604200Medicaid
FL920006634OtherRAILROAD MEDICARE
D57865Medicare UPIN
FL68329WMedicare PIN