Provider Demographics
NPI:1487625398
Name:MCCLELLAND, NAN S (MD)
Entity type:Individual
Prefix:
First Name:NAN
Middle Name:S
Last Name:MCCLELLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NAN
Other - Middle Name:MARIE
Other - Last Name:STEINHAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2606 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4520
Mailing Address - Country:US
Mailing Address - Phone:904-388-4646
Mailing Address - Fax:904-388-9017
Practice Address - Street 1:2606 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4520
Practice Address - Country:US
Practice Address - Phone:904-388-4646
Practice Address - Fax:904-388-9017
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0051656208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0645109-00Medicaid
FLD61105Medicare UPIN