Healthcare Provider Details

I. General information

NPI: 1457306052
Provider Name (Legal Business Name): WILLEM JACOBUS NEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 W SAINT ISABEL ST
TAMPA FL
33607-6343
US

IV. Provider business mailing address

1988 GULF TO BAY BLVD
CLEARWATER FL
33765-3550
US

V. Phone/Fax

Practice location:
  • Phone: 813-253-2273
  • Fax: 813-253-2279
Mailing address:
  • Phone: 727-953-8090
  • Fax: 727-953-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME92249
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME92249
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: