Provider Demographics
NPI:1700276276
Name:AMBROISE, PANANCY
Entity Type:Individual
Prefix:
First Name:PANANCY
Middle Name:
Last Name:AMBROISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6921 ENVIRON BLVD APT 2S
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4209
Mailing Address - Country:US
Mailing Address - Phone:754-281-5057
Mailing Address - Fax:
Practice Address - Street 1:6921 ENVIRON BLVD APT 2S
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4209
Practice Address - Country:US
Practice Address - Phone:754-281-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL220401376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide