Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 305 | FL |
NPI | 1144619594 |
---|---|
Provider Name | Mrs. Agata Nelson |
First Address | Fernandina Beach, FL 32034-3744 |
Second Address | Fernandina Beach, FL 32034-3744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2015 |
Last Update Date | 22/01/2015 |