Provider Demographics
NPI:1811572290
Name:NELSON, ANTOINETTE ELIZABETH (APRN)
Entity Type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:ELIZABETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 KERSFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1937
Mailing Address - Country:US
Mailing Address - Phone:407-620-7529
Mailing Address - Fax:
Practice Address - Street 1:1270 PALM COAST PKWY NW
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4738
Practice Address - Country:US
Practice Address - Phone:386-225-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11030330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily