Provider Demographics
NPI:1891145710
Name:NAVARRO, NELSON JR
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:NAVARRO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 NORTHDALE BLVD
Mailing Address - Street 2:STE 111W
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1853
Mailing Address - Country:US
Mailing Address - Phone:786-507-8278
Mailing Address - Fax:
Practice Address - Street 1:13651 SW 17TH CT
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3449
Practice Address - Country:US
Practice Address - Phone:954-438-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT17788225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist