Individual
JACOB BUTLER NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2605 WELAUNEE BLVD, TALLAHASSEE, FL 32308-4697
(850) 877-8174
(844) 261-6839
Mailing address
3334 CAPITAL MEDICAL BLVD STE 400, TALLAHASSEE, FL 32308-4470
(850) 877-8174
(844) 261-6839
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9109474
FL
363AS0400X
Surgical Physician Assistant
PA9109474
FL
Other
Enumeration date
10/04/2011
Last updated
10/22/2021
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