Provider Demographics
NPI:1427627918
Name:NELSON, JOY JACQUELINE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:JACQUELINE
Last Name:NELSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 NW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-2849
Mailing Address - Country:US
Mailing Address - Phone:954-394-7580
Mailing Address - Fax:
Practice Address - Street 1:412 SE 6TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3405
Practice Address - Country:US
Practice Address - Phone:954-222-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine