Provider Demographics
NPI:1952312076
Name:NANCY K SMITH DBA ESPECIALLY FOR YOU MASTECTOMY BOUTIQUE
Entity Type:Organization
Organization Name:NANCY K SMITH DBA ESPECIALLY FOR YOU MASTECTOMY BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-629-6826
Mailing Address - Street 1:1222 ORANGE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4918
Mailing Address - Country:US
Mailing Address - Phone:407-629-6826
Mailing Address - Fax:407-629-4437
Practice Address - Street 1:1222 ORANGE AVE STE A
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4918
Practice Address - Country:US
Practice Address - Phone:407-629-6826
Practice Address - Fax:407-629-4437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0840020001Medicare NSC