Provider Demographics
NPI:1356417372
Name:ADAM, NANCY M (LMT)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:ADAM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 NW 3RD TER
Mailing Address - Street 2:#102C
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-4884
Mailing Address - Country:US
Mailing Address - Phone:954-675-1201
Mailing Address - Fax:954-522-5108
Practice Address - Street 1:1750 NW 3RD TER
Practice Address - Street 2:#102C
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-4884
Practice Address - Country:US
Practice Address - Phone:954-675-1201
Practice Address - Fax:954-522-5108
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA29642174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist