Healthcare Provider Details

I. General information

NPI: 1588092571
Provider Name (Legal Business Name): NELSON HERNANDO DURAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12271 US HIGHWAY 301 N
PARRISH FL
34219-8410
US

IV. Provider business mailing address

280 S DECATUR BLVD
LAS VEGAS NV
89107-2936
US

V. Phone/Fax

Practice location:
  • Phone: 941-776-4000
  • Fax: 941-776-4013
Mailing address:
  • Phone: 702-759-1238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 9107523
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1898
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: