Basic Information
| Provider Information | |||||||||
| NPI: | 1437107778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | CELIA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD, FACS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 100286 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326100286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522650761 | ||||||||
| FaxNumber: | 3522651060 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 E DIXIE AVE | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347485925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523235762 | ||||||||
| FaxNumber: | 3522651060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 02/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME62340 | FL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 17681 | 01 | FL | BCBS FLORIDA PROVIDER ID | OTHER | ME62340 | 01 | FL | MEDICAL LICENSE | OTHER | 370449100 | 05 | FL | MEDICAID |