Individual
CHRISTIAN NELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11041 COUNTRYSIDE BLVD., TAMPA, FL 33626-3362
(813) 749-0844
(813) 749-0846
Mailing address
11041 COUNTRYSIDE BLVD, TAMPA, FL 33626
(813) 749-0844
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9105890
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA9105890
STATE LICENSE
FL
Enumeration date
01/27/2011
Last updated
01/11/2022
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