Provider Demographics
NPI:1972198802
Name:NELSON, MARISSA A (APRN)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:A
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2353 MISSION RD APT 113
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304-2662
Mailing Address - Country:US
Mailing Address - Phone:850-728-3745
Mailing Address - Fax:
Practice Address - Street 1:2351 PHILLIPS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5333
Practice Address - Country:US
Practice Address - Phone:508-877-8166
Practice Address - Fax:850-877-0431
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011915363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily