Individual
NANCY SOUTHERLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3027 SAN DIEGO RD, JACKSONVILLE, FL 32207-3691
(904) 493-7744
Mailing address
3027 SAN DIEGO RD, JACKSONVILLE, FL 32207-3691
(904) 493-7744
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00
—
FL
Enumeration date
10/28/2021
Last updated
10/28/2021
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