Provider Demographics
NPI:1336704857
Name:NELSON, MONIQUE (APRN)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W PINELOCH AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6100
Mailing Address - Country:US
Mailing Address - Phone:407-635-5060
Mailing Address - Fax:321-842-9869
Practice Address - Street 1:102 W PINELOCH AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6100
Practice Address - Country:US
Practice Address - Phone:407-635-5060
Practice Address - Fax:321-842-9869
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9414396363L00000X
FLAPRN9414396363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner