Basic Information
| Provider Information | |||||||||
| NPI: | 1871752964 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NANCY HUNDT, M.D., P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25086 OLYMPIA AVE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339503933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9415055500 | ||||||||
| FaxNumber: | 9415055501 | ||||||||
| Practice Location | |||||||||
| Address1: | 25086 OLYMPIA AVE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339503933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9415055500 | ||||||||
| FaxNumber: | 9415055501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2008 | ||||||||
| LastUpdateDate: | 06/04/2008 | ||||||||
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| AuthorizedOfficialLastName: | HUNDT | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9415055500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D., P.A. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME0071843 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 42836 | 01 | FL | BCBS | OTHER |