Healthcare Provider Details

I. General information

NPI: 1033296215
Provider Name (Legal Business Name): TANSYLA KEELS NICHOLSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANSYLA DONORA KEELS MD

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 N ALAFAYA TRL
ORLANDO FL
32828-7045
US

IV. Provider business mailing address

10140 CENTURION PKWY N
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 407-273-4132
  • Fax: 407-273-4725
Mailing address:
  • Phone: 904-697-4127
  • Fax: 904-697-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA83966
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME101521
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: