Provider Demographics
NPI:1174597256
Name:SMITH, NANCY KEENEY (LMT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:KEENEY
Last Name:SMITH
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 1:3819 NW 68TH PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-8340
Mailing Address - Country:US
Mailing Address - Phone:352-316-0401
Mailing Address - Fax:
Practice Address - Street 1:3819 NW 68TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-8340
Practice Address - Country:US
Practice Address - Phone:352-316-0401
Practice Address - Fax:352-372-0016
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 38123174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC2145OtherBCBS OF FLORIDA PROVIDER#