Provider Demographics
NPI:1497555031
Name:NELSON, MARIE ANN
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ANN
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ANN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAL HOME, LLC
Mailing Address - Street 1:2529 HAYWOOD ESTATES LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32233-2876
Mailing Address - Country:US
Mailing Address - Phone:904-361-1415
Mailing Address - Fax:
Practice Address - Street 1:2529 HAYWOOD ESTATES LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32233-2876
Practice Address - Country:US
Practice Address - Phone:904-361-1415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist