Provider Demographics
NPI:1881706786
Name:POOLE, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:POOLE
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:PO BOX 1327
Mailing Address - Street 2:224 SE 24TH ST
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:33602
Mailing Address - Country:US
Mailing Address - Phone:352-334-7900
Mailing Address - Fax:352-334-7937
Practice Address - Street 1:224 SE 24TH ST
Practice Address - Street 2:ACHD
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641
Practice Address - Country:US
Practice Address - Phone:352-334-7900
Practice Address - Fax:352-334-7937
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL682502163W00000X
FLAN682502363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305575200Medicaid