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General NPI Number Information
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NPI Number | 1225550593
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Entity Type | Individual
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Provider Name | MICHAEL NELSON
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Gender | Female
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Dates
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Enumeration Date | 07/08/2017
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Last Update Date | 07/08/2017
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Provider Practice Location Address
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Address Line | 13800 VETERANS WAY
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City | ORLANDO
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State | FL
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Zip | 32827-7401
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Country | US
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Telephone | 407-631-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 130 BEASLEY RD
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City | OVIEDO
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State | FL
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Zip | 32765-9497
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Country | US
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Telephone | 321-947-3970
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | CRT92364
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License Number State | FL
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