Provider Demographics
NPI:1417051137
Name:FRANKLIN, NANCY (PA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15215 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6072
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-686-9477
Practice Address - Street 1:5350 SPRINGHILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606
Practice Address - Country:US
Practice Address - Phone:352-688-8116
Practice Address - Fax:352-686-9477
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0258XOtherMEDICARE
FLPA9102009OtherWORK COMP