Provider Demographics
NPI:1457306052
Name:NEL, WILLEM JACOBUS
Entity Type:Individual
Prefix:
First Name:WILLEM
Middle Name:JACOBUS
Last Name:NEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1988 GULF TO BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3550
Mailing Address - Country:US
Mailing Address - Phone:727-953-8090
Mailing Address - Fax:727-953-8088
Practice Address - Street 1:2803 W SAINT ISABEL ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6343
Practice Address - Country:US
Practice Address - Phone:813-253-2273
Practice Address - Fax:813-253-2279
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92249207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00214152OtherMEDICARE RAILROAD
FL272770600Medicaid
FL64362OtherFL BCBS
FL64362YMedicare ID - Type UnspecifiedGTBA MEDICARE
FL64362Medicare ID - Type UnspecifiedFL MEDICARE
FLP00214152OtherMEDICARE RAILROAD