Provider Demographics
NPI:1346414745
Name:NELSON, LARA LYN (APRN)
Entity type:Individual
Prefix:MS
First Name:LARA
Middle Name:LYN
Last Name:NELSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:LARA
Other - Middle Name:LYN
Other - Last Name:NELSON-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2351 SW MARTIN HWY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-3222
Mailing Address - Country:US
Mailing Address - Phone:772-324-9337
Mailing Address - Fax:772-324-9347
Practice Address - Street 1:1066 SW GATLIN BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST. LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953
Practice Address - Country:US
Practice Address - Phone:772-879-8080
Practice Address - Fax:772-424-9347
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25042363LF0000X
TN33103363LF0000X
FLAPRN11004624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily