Healthcare Provider Details

I. General information

NPI: 1891003125
Provider Name (Legal Business Name): DAVID NYLAS CARLSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 01/19/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 UNIVERSITY BLVD S SUITE 700
JACKSONVILLE FL
32216-4230
US

IV. Provider business mailing address

3627 UNIVERSITY BLVD S SUITE 700
JACKSONVILLE FL
32216-4230
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-5678
  • Fax: 904-399-8488
Mailing address:
  • Phone: 904-399-5678
  • Fax: 904-399-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberOTO12631
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: