Provider Demographics
NPI:1710018932
Name:NELSON PRIVETTE, MICHELE (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:NELSON PRIVETTE
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 1:195 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-5572
Mailing Address - Country:US
Mailing Address - Phone:941-408-8988
Mailing Address - Fax:941-408-8846
Practice Address - Street 1:195 CENTER RD
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-5572
Practice Address - Country:US
Practice Address - Phone:941-408-8988
Practice Address - Fax:941-408-8846
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1906052363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6258ZMedicare ID - Type UnspecifiedPROVIDER NO.