Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PTA26955 | FL |
Y | 213ES0000X | Sports Medicine | PTA26955 | FL |
NPI | 1174190854 |
---|---|
Provider Name | Anna Elizabeth Nelson |
First Address | Panama City, FL 32408-5567 |
Second Address | Panama City, FL 32408-5567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2021 |
Last Update Date | 09/06/2021 |