Provider Demographics
NPI:1972306629
Name:FUCIEN, NELSON
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:FUCIEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 34TH ST STE 100P
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-6606
Mailing Address - Country:US
Mailing Address - Phone:407-616-7894
Mailing Address - Fax:
Practice Address - Street 1:3700 34TH ST STE 100P
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-6606
Practice Address - Country:US
Practice Address - Phone:407-616-7894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
FLP183315405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes405300000XOther Service ProvidersPrevention Professional
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty