Provider Demographics
NPI:1083662159
Name:NELSON, TONY JOHN (PA-C, MPAS)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:JOHN
Last Name:NELSON
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Gender:M
Credentials:PA-C, MPAS
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Mailing Address - Street 1:151 SOUTHHALL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:540 MEDICAL OAKS AVE STE 102
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5995
Practice Address - Country:US
Practice Address - Phone:813-651-1991
Practice Address - Fax:813-651-1401
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2019-07-15
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical