Provider Demographics
NPI:1942955091
Name:NEZIER, IMMACULA F (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:IMMACULA
Middle Name:F
Last Name:NEZIER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5313 BROKEN PINE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-8311
Mailing Address - Country:US
Mailing Address - Phone:407-936-4173
Mailing Address - Fax:
Practice Address - Street 1:5300 S JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-7363
Practice Address - Country:US
Practice Address - Phone:407-936-4173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011525207VG0400X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology