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NPI Code Detail

MEDICARE: JACOB BUTLER NELSON PA-C

MEDICARE: JACOB BUTLER NELSON PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA9109474FL
2363A00000XPhysician AssistantPA9109474FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487938833
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB BUTLER NELSON PA-C
Provider Business Mailing Address
First Line : 3334 CAPITAL MEDICAL BLVD STE 400
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-4470
Country : US
Telephone Number : 850-877-8174
Fax Number : 844-261-6839
Provider Business Practice Location Address
First Line : 2605 WELAUNEE BLVD
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32308-4697
Country : US
Telephone Number : 850-877-8174
Fax Number : 844-261-6839
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2011
Last Update Date : 10/22/2021

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