Provider Demographics
NPI:1558055202
Name:NELSON, DAVONNE
Entity Type:Individual
Prefix:
First Name:DAVONNE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SPRING RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-3725
Mailing Address - Country:US
Mailing Address - Phone:321-263-9936
Mailing Address - Fax:
Practice Address - Street 1:1565 SAXON BLVD STE 201
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5836
Practice Address - Country:US
Practice Address - Phone:386-532-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program