Provider Demographics
NPI:1427271816
Name:ERVIN, PENNY N (RN, RNFA)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:N
Last Name:ERVIN
Suffix:
Gender:F
Credentials:RN, RNFA
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 15
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32616-0015
Mailing Address - Country:US
Mailing Address - Phone:386-462-5077
Mailing Address - Fax:
Practice Address - Street 1:6440 W NEWBERRY RD
Practice Address - Street 2:SUITE 401
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4381
Practice Address - Country:US
Practice Address - Phone:352-332-0030
Practice Address - Fax:352-332-0039
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 3062222163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN 3062222OtherMEDICAL LICENSE