Eric Nelson

 
 2023/02/04 04:45 PM 
 TO: 16103548946 FROM: 8355826968 
 Page: 90 
 Advanced Rx 
 360 Ortho and Spine 
 Stefan Prada, MD 
 Optimizing Provider Care鈩 
 DEA # BP3793696 
 11809 N Dale Mabry Hwy 
 Tampa, FL 33618 
 Patient Name: Eric Nelson
 DOB: 1986/24/02 DOI: 2020/08/10
 Address: 1119 CR 457 Lake Danasoffhee FC 33538 
 ICD-10: HS4.2 

 Physician Signature: 
 RO, 
 Date: 2018/22/06
 (MM/DD/YYYY) 
 Patient Signature: Jordan Walsh 
 2018/07/09
 Date: 
 (MM/DD/YYYY) 
 www.Advanced-Rx.com I Phone 88855826 I Fax 92555826
 2430 Camino Ramon, Suite 120, San Ramon, CA 94565
