Provider Demographics
NPI:1912234808
Name:ENCARNACION, NESTOR DAVID
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:DAVID
Last Name:ENCARNACION
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 MAYAN PL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-3256
Mailing Address - Country:US
Mailing Address - Phone:407-520-1901
Mailing Address - Fax:
Practice Address - Street 1:607 MAYAN PL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34758-3256
Practice Address - Country:US
Practice Address - Phone:407-520-1901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL09-294246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist