1407831282 NPI number — NANCY A BOYD ARNP

Table of content: NANCY A BOYD ARNP (NPI 1407831282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407831282 NPI number — NANCY A BOYD ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYD
Provider First Name:
NANCY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407831282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1302 RIVER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALATKA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32177-5042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-328-8371
Provider Business Mailing Address Fax Number:
385-328-1519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 WHITEHALL DR
Provider Second Line Business Practice Location Address:
SUITE 109-114
Provider Business Practice Location Address City Name:
ST AUGUSTINE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32086-5269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-829-2782
Provider Business Practice Location Address Fax Number:
904-829-2494
Provider Enumeration Date:
12/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  ARNP1098192 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: ARNP1098192 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: ARNP1098192 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 301748601 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y5910 . This is a "NETWORK BLUE PPS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 080193404 . This is a "RR MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1934541 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 149767 . This is a "HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 301748600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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