Provider Demographics
NPI:1477683456
Name:NABORS, JAN M (LDO)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:M
Last Name:NABORS
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 SADLER RD
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4426
Mailing Address - Country:US
Mailing Address - Phone:904-261-5955
Mailing Address - Fax:904-261-5956
Practice Address - Street 1:1480 SADLER RD
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4426
Practice Address - Country:US
Practice Address - Phone:904-261-5955
Practice Address - Fax:904-261-5956
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 2808156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician