Healthcare Provider Details

I. General information

NPI: 1922994516
Provider Name (Legal Business Name): VONETTA MOLICA PROWELL APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 SAXON BLVD STE 207
DELTONA FL
32725-3279
US

IV. Provider business mailing address

2120 SAXON BLVD STE 207
DELTONA FL
32725-3279
US

V. Phone/Fax

Practice location:
  • Phone: 347-834-6566
  • Fax: 347-834-6566
Mailing address:
  • Phone: 347-834-6566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11040226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: