Provider Demographics
NPI:1255646436
Name:MINCY, MINNIE A (RN)
Entity type:Individual
Prefix:
First Name:MINNIE
Middle Name:A
Last Name:MINCY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1310 N SHORE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-3536
Mailing Address - Country:US
Mailing Address - Phone:352-728-4752
Mailing Address - Fax:352-728-4750
Practice Address - Street 1:1310 N SHORE DR
Practice Address - Street 2:SUITE B
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3536
Practice Address - Country:US
Practice Address - Phone:352-728-4752
Practice Address - Fax:352-728-4750
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRN9280650251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care