Provider Demographics
NPI:1710233606
Name:ANDERSON, NANCY LYNN (N/A)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LYNN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:LYNN
Other - Last Name:CULBREATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:N/A
Mailing Address - Street 1:3941 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-2527
Mailing Address - Country:US
Mailing Address - Phone:727-723-4475
Mailing Address - Fax:727-723-4475
Practice Address - Street 1:3941 13TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-2527
Practice Address - Country:US
Practice Address - Phone:727-723-4475
Practice Address - Fax:727-723-4475
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232754253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care