Provider Demographics
NPI:1790898690
Name:VANCE, NANCY J (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:VANCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:J
Other - Last Name:ANTONACCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4888 DAVIS BLVD
Mailing Address - Street 2:#290
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-5338
Mailing Address - Country:US
Mailing Address - Phone:859-948-5422
Mailing Address - Fax:239-261-0141
Practice Address - Street 1:1500 5TH AVE S
Practice Address - Street 2:SUITE 104
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-3492
Practice Address - Country:US
Practice Address - Phone:239-261-0074
Practice Address - Fax:239-261-0141
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106180146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant