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General NPI Number Information
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NPI Number | 1881567436
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Entity Type | Individual
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Provider Name | TAMARA PATRICE NEILSON PHMNP
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Gender | Female
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 3425 BAYSIDE LAKES BLVD SE STE 103
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City | PALM BAY
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State | FL
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Zip | 32909-6867
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Country | US
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Telephone | 321-353-8763
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Fax |
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Provider Business Mailing Address
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Address Line | 128 ALDEA DR
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City | SEBASTIAN
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State | FL
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Zip | 32958-6949
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Country | US
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Telephone | 772-646-8618
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11042384
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License Number State | FL
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