Provider Demographics
NPI:1912262601
Name:NELSON, THELMA TERESA (ARNP)
Entity type:Individual
Prefix:
First Name:THELMA
Middle Name:TERESA
Last Name:NELSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14690 SPRING HILL DR STE 305
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-799-0046
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:12900 CORTEZ BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6828
Practice Address - Country:US
Practice Address - Phone:352-597-7744
Practice Address - Fax:352-597-7797
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9269374363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGM347ZMedicare PIN