Provider Demographics
NPI:1437418233
Name:PREVATT, NANCY FAYE (RN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:FAYE
Last Name:PREVATT
Suffix:
Gender:F
Credentials:RN
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 202
Mailing Address - Street 2:1118 3RD STREET
Mailing Address - City:PALMDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33944-0202
Mailing Address - Country:US
Mailing Address - Phone:863-673-6812
Mailing Address - Fax:863-675-0020
Practice Address - Street 1:1118 3RD STREET
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:FL
Practice Address - Zip Code:33944
Practice Address - Country:US
Practice Address - Phone:863-673-6812
Practice Address - Fax:863-675-0020
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9170880374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula