Individual
MR. DEREK NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1055 SAXON BLVD, ORANGE CITY, FL 32763-8468
(386) 917-5000
Mailing address
4440 RIVER BOTTOM DR, NORCROSS, GA 30092-1364
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9106084
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0042720-00
—
FL
Enumeration date
09/16/2011
Last updated
01/11/2013
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