Provider Demographics
NPI:1366405623
Name:LANDFISH, NANCY K (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:K
Last Name:LANDFISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:401 N PARSONS AVE
Mailing Address - Street 2:SUITE 108B
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4538
Mailing Address - Country:US
Mailing Address - Phone:813-571-5244
Mailing Address - Fax:813-643-5820
Practice Address - Street 1:119 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5779
Practice Address - Country:US
Practice Address - Phone:813-571-5244
Practice Address - Fax:813-571-5242
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME571422080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250107400Medicaid
FL250107400Medicaid