Provider Demographics
NPI:1649242900
Name:NELSON, KIRK A (DO)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:A
Last Name:NELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 MEASE DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-6602
Mailing Address - Country:US
Mailing Address - Phone:727-725-6128
Mailing Address - Fax:727-725-6168
Practice Address - Street 1:1840 MEASE DR
Practice Address - Street 2:SUITE 307
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-6602
Practice Address - Country:US
Practice Address - Phone:727-725-6128
Practice Address - Fax:727-725-6168
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13561207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO242517431Medicaid
MOC51398Medicare UPIN
MO000095156Medicare ID - Type Unspecified