Provider Demographics
NPI:1710200910
Name:NANAN, GILBERT
Entity Type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:
Last Name:NANAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4141
Mailing Address - Country:US
Mailing Address - Phone:407-463-5291
Mailing Address - Fax:407-880-3593
Practice Address - Street 1:48 E OAK ST
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4141
Practice Address - Country:US
Practice Address - Phone:407-463-5291
Practice Address - Fax:407-880-3593
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11395310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001605000Medicaid