Provider Demographics
NPI:1659926897
Name:NELSON, JENNIFER L (CAREGIVER)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 DRIFTWOOD POINT RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-3020
Mailing Address - Country:US
Mailing Address - Phone:850-830-4217
Mailing Address - Fax:
Practice Address - Street 1:514 DRIFTWOOD POINT RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-3020
Practice Address - Country:US
Practice Address - Phone:850-830-4217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider