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Individual

NANCY ANN VAIL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LMT

Contact information

Practice address
208 SOUTHPARK CIR E, ST AUGUSTINE, FL 32086-5135
(904) 501-1271
Mailing address
208 SOUTHPARK CIR E, ST AUGUSTINE, FL 32086-5135
(904) 501-1271

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MA 4534
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
C5055
BLUE CROSS BLUE SHIELD PROVIDER NUMBER
FL
Enumeration date
08/27/2010
Last updated
08/27/2010
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