Provider Demographics
NPI:1508128729
Name:NANCY WRIGHT MD P.A.
Entity Type:Organization
Organization Name:NANCY WRIGHT MD P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-656-3361
Mailing Address - Street 1:1804 MICCOSUKEE COMMONS DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5470
Mailing Address - Country:US
Mailing Address - Phone:850-656-3361
Mailing Address - Fax:850-656-6870
Practice Address - Street 1:1804 MICCOSUKEE COMMONS DR
Practice Address - Street 2:SUITE 210
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5470
Practice Address - Country:US
Practice Address - Phone:850-656-3361
Practice Address - Fax:850-656-6870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME722212080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251486900Medicaid