Provider Demographics
NPI:1659990760
Name:NILSON, JONATHAN C (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:C
Last Name:NILSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 RIBELIN RANCH DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-8585
Mailing Address - Country:US
Mailing Address - Phone:512-345-7436
Mailing Address - Fax:512-346-7436
Practice Address - Street 1:7011 RIBELIN RANCH RD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8585
Practice Address - Country:US
Practice Address - Phone:512-345-7436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU5775207Q00000X
FLME162557207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine