Provider Demographics
NPI:1295735710
Name:NIELSEN, JAMES L (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:NIELSEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1720 SE 16TH AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4620
Mailing Address - Country:US
Mailing Address - Phone:352-369-0288
Mailing Address - Fax:352-867-1053
Practice Address - Street 1:1600 N GRAND AVE STE 500
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2757
Practice Address - Country:US
Practice Address - Phone:719-545-0663
Practice Address - Fax:719-595-7903
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65879208G00000X
COCDR.0004932208G00000X
WI1425208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009409040Medicaid
FL3756050 00Medicaid
FL3756050 00Medicaid
FL3756050 00Medicaid