Provider Demographics
NPI:1376077347
Name:CALVO, NELSON AHMED (APRN)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:AHMED
Last Name:CALVO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:NELSON
Other - Middle Name:
Other - Last Name:CALVO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:20371 NW 32ND CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1854
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3001 NW 49TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7257
Practice Address - Country:US
Practice Address - Phone:954-983-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9439535163W00000X
FL17-256246ZC0007X
FL11000056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant