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NPI Code Detail

MEDICARE: LAURA A VAN HORN-NELSON PA

MEDICARE: LAURA A VAN HORN-NELSON PA
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
1363A00000XPhysician Assistant
2207Q00000XFamily Medicine PhysicianPA0002503FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA0002503OTHERFLFL LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699774471
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA A VAN HORN-NELSON PA
Provider Business Mailing Address
First Line : 130 HEALTH PARK BLVD
Second Line :
City : SAINT AUGUSTINE
State : FL
Zip : 32086-5776
Country : US
Telephone Number : 904-826-3469
Fax Number : 904-808-4608
Provider Business Practice Location Address
First Line : 130 HEALTH PARK BLVD
Second Line :
City : SAINT AUGUSTINE
State : FL
Zip : 32086-5776
Country : US
Telephone Number : 904-826-3469
Fax Number : 904-808-4608
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 04/05/2020

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1407173917 — MR. MICHAEL STANLEY JECEN PA
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Directions to “ LAURA A VAN HORN-NELSON PA” Practice Location

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