Provider Demographics
NPI:1528048568
Name:KONOW, NANCY ANNETTE (LDH)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANNETTE
Last Name:KONOW
Suffix:
Gender:F
Credentials:LDH
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:ANNETTE
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDH
Mailing Address - Street 1:103 STRAWBERRY RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-3571
Mailing Address - Country:US
Mailing Address - Phone:813-685-0735
Mailing Address - Fax:
Practice Address - Street 1:15100 RESCUE WAY
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3524
Practice Address - Country:US
Practice Address - Phone:727-535-1437
Practice Address - Fax:727-535-4190
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13001281A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist