| Doctor Name: | MRS. AGATA NELSON |
| NPI Number: | 1144619594 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LM |
| License Number: | 305 |
| Business Practice Address: | 910 S 8th St Suite 100 Fernandina Beach, FL - 320343744 |
| Business Phone Number: | 9048754278 |
| Business Fax Number: | 9045721571 |
| Mailing Address: | 910 S 8th St, Suite 100 FERNANDINA BEACH |
| State: | FL |
| Postal Code: | 320343744 |
| Phone Number: | 9048754278 |
| Fax Number: | 9045721571 |
| NPI Enumeration Date: | 01/22/2015 |
| NPI Last Update Date: | 01/22/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207VX0000X |
| License Number: | 305 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | Obstetrics |
| Taxonomy Definition: | |