Healthcare Provider Details

I. General information

NPI: 1083967772
Provider Name (Legal Business Name): NELSON CARL HULBERT D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13761 MCGREGOR BLVD
FORT MYERS FL
33919-6120
US

IV. Provider business mailing address

13761 MCGREGOR BLVD
FORT MYERS FL
33919-6120
US

V. Phone/Fax

Practice location:
  • Phone: 239-482-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: