Provider Demographics
NPI:1811932817
Name:THORNTON, NANCY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LYNN
Last Name:THORNTON
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 1:2700 PGA BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2958
Mailing Address - Country:US
Mailing Address - Phone:561-625-1116
Mailing Address - Fax:561-625-6911
Practice Address - Street 1:2700 PGA BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2958
Practice Address - Country:US
Practice Address - Phone:561-625-1116
Practice Address - Fax:561-625-6911
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009513600Medicaid
FL009513600Medicaid
FLE66528Medicare UPIN