Provider Demographics
NPI:1487268215
Name:DIMIAN, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DIMIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W ARDICE AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6240
Mailing Address - Country:US
Mailing Address - Phone:352-589-5062
Mailing Address - Fax:352-589-9263
Practice Address - Street 1:101 W ARDICE AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6240
Practice Address - Country:US
Practice Address - Phone:352-589-5062
Practice Address - Fax:352-589-9263
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55765183500000X
FLPS55764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist