Healthcare Provider Details

I. General information

NPI: 1487545315
Provider Name (Legal Business Name): MR. THOMAS NELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 VENTURA AVE
SANTA ROSA CA
95403-2226
US

IV. Provider business mailing address

2777 VENTURA AVE
SANTA ROSA CA
95403-2226
US

V. Phone/Fax

Practice location:
  • Phone: 707-565-1400
  • Fax:
Mailing address:
  • Phone: 650-303-2501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95035369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: