Basic Information
| Provider Information | |||||||||
| NPI: | 1700819612 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAYTON | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | LR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 E NEW HAVEN AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329014576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217298223 | ||||||||
| FaxNumber: | 3217296252 | ||||||||
| Practice Location | |||||||||
| Address1: | 307 E NEW HAVEN AVE | ||||||||
| Address2: | |||||||||
| City: | MELBOURNE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329014576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3217298223 | ||||||||
| FaxNumber: | 3217296252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 12/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | ME51048 | FL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 062221400 | 05 | FL | MEDICAID |