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NPI Code Detail

MEDICARE: MR. JUAN CARLOS NELSON MAED CAP

MEDICARE: MR. JUAN CARLOS NELSON MAED CAP
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
1101YA0400XAddiction (Substance Use Disorder) Counselor4983FL

General Provider Information

NPI Number : 1841592185
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JUAN CARLOS NELSON MAED CAP
Provider Business Mailing Address
First Line : 4422 E COLUMBUS DR
Second Line :
City : TAMPA
State : FL
Zip : 33605-3233
Country : US
Telephone Number : 813-384-4121
Fax Number :
Provider Business Practice Location Address
First Line : 4422 E COLUMBUS DR
Second Line :
City : TAMPA
State : FL
Zip : 33605-3233
Country : US
Telephone Number : 813-384-4121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2010
Last Update Date : 11/18/2010

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