Provider Demographics
NPI:1578642336
Name:NELSON, GRETCHEN (ARNP)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12700 CREEKSIDE LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3356
Mailing Address - Country:US
Mailing Address - Phone:239-432-0774
Mailing Address - Fax:239-432-0229
Practice Address - Street 1:12700 CREEKSIDE LN
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3356
Practice Address - Country:US
Practice Address - Phone:239-432-0774
Practice Address - Fax:239-432-0229
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1898852363AM0700X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical