MEDICARE: AMANDA L NELSON CRNA

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	367500000X	Certified Registered Nurse Anesthetist	747301	TX
2	367500000X	Certified Registered Nurse Anesthetist	4704373720	MI

General Provider Information

NPI Number	:	1265703151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA L NELSON CRNA

Provider Business Mailing Address
First Line	:	1613 HARRISON PKWY
Second Line	:	SUITE 200
City	:	SUNRISE
State	:	FL
Zip	:	33323-2896
Country	:	US
Telephone Number	:	954-838-2371
Fax Number	:	954-851-1746

Provider Business Practice Location Address
First Line	:	4400 NEW YORK AVE
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76018-4817
Country	:	US
Telephone Number	:	817-852-8500
Fax Number	:

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

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	07/21/2021

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