Provider Demographics
NPI:1841327236
Name:NIEVES, NELSON ANTONIO (MD)
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:ANTONIO
Last Name:NIEVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45669 HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-4546
Mailing Address - Country:US
Mailing Address - Phone:863-866-2551
Mailing Address - Fax:863-866-2552
Practice Address - Street 1:45669 HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-4546
Practice Address - Country:US
Practice Address - Phone:407-438-5858
Practice Address - Fax:407-438-7172
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001399200Medicaid
H11970Medicare UPIN
FL001399200Medicaid