Healthcare Provider Details

I. General information

NPI: 1174182273
Provider Name (Legal Business Name): NELLIE J BAEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10125 W COLONIAL DR STE 205
OCOEE FL
34761-4200
US

IV. Provider business mailing address

10125 W COLONIAL DR STE 205
OCOEE FL
34761-4200
US

V. Phone/Fax

Practice location:
  • Phone: 407-578-1241
  • Fax: 407-578-1242
Mailing address:
  • Phone: 407-578-1241
  • Fax: 407-578-1242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11002680
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11002680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: