Provider Demographics
NPI:1639153463
Name:NELSON, MARK LINDER (CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LINDER
Last Name:NELSON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 LEMON ST
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5249
Mailing Address - Country:US
Mailing Address - Phone:727-418-4538
Mailing Address - Fax:
Practice Address - Street 1:331 LEMON ST
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5249
Practice Address - Country:US
Practice Address - Phone:727-418-4538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3069322367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2883OtherBCBS
FL303934000Medicaid
P00215132OtherRAILROAD MEDICARE
P00215132OtherRAILROAD MEDICARE
FLG2883Medicare ID - Type Unspecified