Provider Demographics
NPI:1700819612
Name:LAYTON, NANCY LR (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LR
Last Name:LAYTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E NEW HAVEN AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-4576
Mailing Address - Country:US
Mailing Address - Phone:321-729-8223
Mailing Address - Fax:321-729-6252
Practice Address - Street 1:307 E NEW HAVEN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4576
Practice Address - Country:US
Practice Address - Phone:321-729-8223
Practice Address - Fax:321-729-6252
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51048208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062221400Medicaid
FL062221400Medicaid
FL07924WMedicare PIN