Provider Demographics
NPI:1174737944
Name:NELSON SOTO, ANTHONY (1532B)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:NELSON SOTO
Suffix:
Gender:M
Credentials:1532B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 ASSEMBLY CT
Mailing Address - Street 2:
Mailing Address - City:REUNION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-6760
Mailing Address - Country:US
Mailing Address - Phone:786-817-7861
Mailing Address - Fax:
Practice Address - Street 1:5579 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:FL
Practice Address - Zip Code:32809-3493
Practice Address - Country:US
Practice Address - Phone:407-241-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11043155363LF0000X
FL9532827163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse