Provider Demographics
NPI:1942298435
Name:EKLUND, NANCY MARIE (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:MARIE
Last Name:EKLUND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14220 SW 79TH AVE
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1509
Mailing Address - Country:US
Mailing Address - Phone:305-270-2229
Mailing Address - Fax:305-270-2284
Practice Address - Street 1:8353 SW 124TH ST STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-5847
Practice Address - Country:US
Practice Address - Phone:305-270-2229
Practice Address - Fax:305-270-2284
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0033220207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D63404Medicare UPIN
26352Medicare ID - Type Unspecified