Provider Demographics
NPI:1487706156
Name:AMBRIANO, NANCYANN (PA-C)
Entity type:Individual
Prefix:
First Name:NANCYANN
Middle Name:
Last Name:AMBRIANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5597 N DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3406
Mailing Address - Country:US
Mailing Address - Phone:954-229-7962
Mailing Address - Fax:954-229-7912
Practice Address - Street 1:5597 N DIXIE HWY
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3406
Practice Address - Country:US
Practice Address - Phone:954-229-7962
Practice Address - Fax:954-229-7912
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0734SMedicare UPIN
FLBR885BMedicare PIN
FLBR885AMedicare PIN
P90165Medicare UPIN
FLU0734WMedicare UPIN
FLU0734TMedicare UPIN
FLBR885CMedicare PIN