MEDICARE: TASHEKA FIONA NELSON

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	225700000X	Massage Therapist	L17000024455	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	79218	OTHER	FL	FLORIDA MASSAGE THERAPIST LICENSE
2	79218	OTHER	FL	FLORIDA MASSAGE LICENSE

General Provider Information

NPI Number	:	1407454432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHEKA FIONA NELSON

Provider Business Mailing Address
First Line	:	2546 DOVETAIL DR
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-8649
Country	:	US
Telephone Number	:	757-202-8572
Fax Number	:	321-352-7901

Provider Business Practice Location Address
First Line	:	2910 MAGUIRE RD STE 1002
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-4742
Country	:	US
Telephone Number	:	407-654-0557
Fax Number	:

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

Provider Enumeration Date	:	10/12/2020
Last Update Date	:	10/12/2020

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Directions to “ TASHEKA FIONA NELSON ” Practice Location

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