Healthcare Provider Details

I. General information

NPI: 1649090457
Provider Name (Legal Business Name): NELLIE SKILLEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1762 WESTWOOD BLVD STE 300
LOS ANGELES CA
90024-5641
US

IV. Provider business mailing address

2090 PALM BEACH LAKES BLVD STE 700
WEST PALM BEACH FL
33409-6508
US

V. Phone/Fax

Practice location:
  • Phone: 561-422-4206
  • Fax:
Mailing address:
  • Phone: 561-422-4206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: