Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO3581 | FL |
NPI | 1043217425 |
---|---|
Provider Name | Nicole D Hancock |
First Address | Leesburg, FL 34748-3959 |
Second Address | Leesburg, FL 34748-3959 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 08/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8AD031 | BLUE CROSS/BLUE SHIELD (01) |