MEDICARE: DR. ANNETTE NICOLE NIELSEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME93223	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053310185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNETTE NICOLE NIELSEN MD

Provider Business Mailing Address
First Line	:	9743 SELTEN WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7933
Country	:	US
Telephone Number	:	407-736-8733
Fax Number	:	407-736-8669

Provider Business Practice Location Address
First Line	:	9743 SELTEN WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7933
Country	:	US
Telephone Number	:	407-736-8733
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	10/02/2024

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