Provider Demographics
NPI:1427127315
Name:KING, NANCY DAVIS (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:DAVIS
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 NEWBERN CIR
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-3348
Mailing Address - Country:US
Mailing Address - Phone:863-965-1288
Mailing Address - Fax:863-967-1297
Practice Address - Street 1:125 NEWBERN CIR
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:FL
Practice Address - Zip Code:33823-3348
Practice Address - Country:US
Practice Address - Phone:863-965-1288
Practice Address - Fax:863-967-1297
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00582182083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE66537Medicare UPIN