Healthcare Provider Details

I. General information

NPI: 1134046261
Provider Name (Legal Business Name): NELCARE PRIMARY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 W CORPORATE OAKS DR
CRYSTAL RIVER FL
34429-2705
US

IV. Provider business mailing address

6202 W CORPORATE OAKS DR
CRYSTAL RIVER FL
34429-2705
US

V. Phone/Fax

Practice location:
  • Phone: 407-920-7787
  • Fax:
Mailing address:
  • Phone: 407-920-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN DAVIS
Title or Position: OWNER
Credential: APRN
Phone: 407-920-7787