Provider Demographics
NPI:1184019853
Name:NELSON T CACERES LLC
Entity Type:Organization
Organization Name:NELSON T CACERES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:T
Authorized Official - Last Name:CACERES
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:305-775-1775
Mailing Address - Street 1:PO BOX 831082
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33283-1082
Mailing Address - Country:US
Mailing Address - Phone:305-775-1775
Mailing Address - Fax:
Practice Address - Street 1:6021 SW 109TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1246
Practice Address - Country:US
Practice Address - Phone:305-775-1775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty