Provider Demographics
NPI:1992036255
Name:NANCY EKLUND MD PA
Entity Type:Organization
Organization Name:NANCY EKLUND MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EKLUND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-270-2229
Mailing Address - Street 1:14220 SW 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1509
Mailing Address - Country:US
Mailing Address - Phone:305-270-2229
Mailing Address - Fax:305-270-2284
Practice Address - Street 1:9085 SW 87TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2309
Practice Address - Country:US
Practice Address - Phone:305-270-2229
Practice Address - Fax:305-270-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63404Medicare UPIN