Provider Demographics
NPI:1073832747
Name:NELSON, MICHELLE RENAE (RRT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:RENAE
Last Name:NELSON
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:RENAE
Other - Last Name:WILKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RRT
Mailing Address - Street 1:4229 SW 68TH TER
Mailing Address - Street 2:UNIT D
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-6479
Mailing Address - Country:US
Mailing Address - Phone:352-443-9303
Mailing Address - Fax:352-264-0392
Practice Address - Street 1:4229 SW 68TH TER
Practice Address - Street 2:UNIT D
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-6479
Practice Address - Country:US
Practice Address - Phone:352-443-9303
Practice Address - Fax:352-264-0392
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT9149227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered