MEDICARE: MARYALICE NELSON ARNP

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
1	363LW0102X	Women's Health Nurse Practitioner	ARNP 1850332	FL

General Provider Information

NPI Number	:	1568456135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYALICE NELSON ARNP

Provider Business Mailing Address
First Line	:	884 SW 51ST WAY
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-3858
Country	:	US
Telephone Number	:	352-374-2224
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 SW ARCHER RD
Second Line	:	GU CLINIC
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-1135
Country	:	US
Telephone Number	:	352-548-6181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	08/05/2013

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