Individual
KYLE NIELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1800 SE TIFFANY AVE, PORT ST LUCIE, FL 34952-7521
(623) 556-3784
Mailing address
13657 W REMUDA DR, PEORIA, AZ 85383-8306
(623) 556-3784
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
OS19626
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/24/2019
Last updated
06/01/2023
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