Provider Demographics
NPI:1790371474
Name:PRATT, NANCY JO (PSYD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JO
Last Name:PRATT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 PERSHING ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1836
Mailing Address - Country:US
Mailing Address - Phone:904-303-6180
Mailing Address - Fax:
Practice Address - Street 1:2514 HOLLYWOOD BLVD STE 500
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6635
Practice Address - Country:US
Practice Address - Phone:256-397-5564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10988103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist