Basic Information
| Provider Information | |||||||||
| NPI: | 1588092571 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DURAN | ||||||||
| FirstName: | NELSON | ||||||||
| MiddleName: | HERNANDO | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 S DECATUR BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891072936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027591238 | ||||||||
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| Practice Location | |||||||||
| Address1: | 12271 US HIGHWAY 301 N | ||||||||
| Address2: | |||||||||
| City: | PARRISH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342198410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417764000 | ||||||||
| FaxNumber: | 9417764013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2013 | ||||||||
| LastUpdateDate: | 10/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA 9107523 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | PA1898 | NV | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.