Provider Demographics
NPI:1811443161
Name:NELSON, DENA MARIE (CASE MANAGER)
Entity type:Individual
Prefix:
First Name:DENA MARIE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 N COURTENAY PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4101
Mailing Address - Country:US
Mailing Address - Phone:877-404-9995
Mailing Address - Fax:877-404-9995
Practice Address - Street 1:125 E MERRITT ISLAND CSWY # 107-357
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3699
Practice Address - Country:US
Practice Address - Phone:321-355-7701
Practice Address - Fax:321-355-7701
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
FL234339376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No376J00000XNursing Service Related ProvidersHomemaker