Individual
MR. WILLIAM AAGE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
714 JACKSON ST N, ST PETERSBURG, FL 33705-1337
(727) 895-4663
Mailing address
714 JACKSON ST N, ST PETERSBURG, FL 33705-1337
(727) 895-4663
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
65
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
141550600
—
FL
Enumeration date
06/02/2008
Last updated
06/02/2008
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