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General NPI Number Information
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NPI Number | 1417077827
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Entity Type | Individual
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Provider Name | MICHAEL D NISSEN N.P.-C
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Gender | Male
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 3399 FERRIS CIR
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City | VERNON
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State | FL
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Zip | 32462-2217
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Country | US
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Telephone | 706-594-6919
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Fax |
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Provider Business Mailing Address
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Address Line | 3399 FERRIS CIR
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City | VERNON
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State | FL
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Zip | 32462-2217
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Country | US
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Telephone | 706-594-6919
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 242756
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11026653
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License Number State | FL
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