Provider Demographics
NPI:1710220082
Name:NUNNELLY, JANE FRAZIER (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:FRAZIER
Last Name:NUNNELLY
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 1:5963 BAYVIEW CIR S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-3929
Mailing Address - Country:US
Mailing Address - Phone:727-343-4005
Mailing Address - Fax:
Practice Address - Street 1:5963 BAYVIEW CIR S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-3929
Practice Address - Country:US
Practice Address - Phone:727-343-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME563172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology