Provider Demographics
NPI:1720032485
Name:NELSON, TORILL P
Entity Type:Individual
Prefix:
First Name:TORILL
Middle Name:P
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TORILL
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1017 FAIR ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4408
Mailing Address - Country:US
Mailing Address - Phone:803-424-1260
Mailing Address - Fax:803-424-1230
Practice Address - Street 1:1017 FAIR ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4408
Practice Address - Country:US
Practice Address - Phone:803-424-1260
Practice Address - Fax:803-424-1230
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1010163WP2201X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ316348042Medicare ID - Type Unspecified