Provider Demographics
NPI:1487714309
Name:STRICKLAND, NANCY ELIZABETH (PAC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ELIZABETH
Last Name:STRICKLAND
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:JERNIGAN
Other - Last Name:STRICKLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:264 JERNIGAN FARM RD
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31634-5302
Mailing Address - Country:US
Mailing Address - Phone:912-487-5211
Mailing Address - Fax:912-487-3367
Practice Address - Street 1:80 HUXFORD ST
Practice Address - Street 2:
Practice Address - City:HOMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31634-2356
Practice Address - Country:US
Practice Address - Phone:912-487-1737
Practice Address - Fax:912-487-1739
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003413363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100000864AMedicaid
GA97BBGFWMedicare ID - Type Unspecified
GA100000864AMedicaid