Provider Demographics
NPI:1497125942
Name:FONG-EDWARDS, NANCY NATALIE
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:NATALIE
Last Name:FONG-EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8645 N MILITARY TRL STE 508
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6296
Mailing Address - Country:US
Mailing Address - Phone:561-630-8001
Mailing Address - Fax:561-630-8007
Practice Address - Street 1:800 CLEMATIS ST RM 5531
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-5107
Practice Address - Country:US
Practice Address - Phone:561-671-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-27
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9327531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily