Provider Demographics
NPI:1821415043
Name:NANCE, ERICA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:NANCE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:M
Other - Last Name:GILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:3100 PLAZA PROPERTIES BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1530
Practice Address - Country:US
Practice Address - Phone:614-383-6000
Practice Address - Fax:614-383-6001
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004036363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0124077Medicaid
OH0124077Medicaid