Provider Demographics
NPI:1306722061
Name:NELSON, KATERINA NICOLE (CSTFA)
Entity type:Individual
Prefix:
First Name:KATERINA
Middle Name:NICOLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:CSTFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 TUDOR ROSE DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32773-7392
Mailing Address - Country:US
Mailing Address - Phone:850-630-6432
Mailing Address - Fax:
Practice Address - Street 1:2148 TUDOR ROSE DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-7392
Practice Address - Country:US
Practice Address - Phone:850-630-6432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0136001033246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist