MEDICARE: JAY ANDREW NELSON, D.M.D., P.A.

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	122300000X	Dentist	DN10809	FL
2	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1164721510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAY ANDREW NELSON, D.M.D., P.A.

Provider Business Mailing Address
First Line	:	26907 FOGGY CREEK RD STE 101
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6778
Country	:	US
Telephone Number	:	813-733-4169
Fax Number	:	888-977-1984

Provider Business Practice Location Address
First Line	:	26907 FOGGY CREEK RD STE 101
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6778
Country	:	US
Telephone Number	:	813-733-4169
Fax Number	:	888-977-1984

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAY A NELSON
Credential	:	D.M.D.
Telephone Number	:	813-733-4169

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	08/24/2021

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