MEDICARE: MRS. WINIFRED NELSON FNP-C

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	363L00000X	Nurse Practitioner	F01260078	FL

General Provider Information

NPI Number	:	1093664021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WINIFRED NELSON FNP-C

Provider Business Mailing Address
First Line	:	2073 PALMETTO ST
Second Line	:
City	:	MIDDLEBURG
State	:	FL
Zip	:	32068-5151
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 BELFORT RD STE 102
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8208
Country	:	US
Telephone Number	:	904-371-4051
Fax Number	:	904-619-4378

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

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/23/2026

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