1821042425 NPI number — MS. NANCY DEANE NEWBURY ARNP

Table of content: MS. NANCY DEANE NEWBURY ARNP (NPI 1821042425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821042425 NPI number — MS. NANCY DEANE NEWBURY ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWBURY
Provider First Name:
NANCY
Provider Middle Name:
DEANE
Provider Name Prefix Text:
MS.
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:
1821042425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9220 SE LACREEK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOBE SOUND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33455-8954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-545-3993
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 W MIDWAY RD
Provider Second Line Business Practice Location Address:
NEW HORIZONS OF THE TREASURE COAST INC
Provider Business Practice Location Address City Name:
FT PIERCE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-221-4088
Provider Business Practice Location Address Fax Number:
772-221-4089
Provider Enumeration Date:
05/19/2006

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: 363LP0808X , with the licence number:  1161862 , 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: 763243600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".