Healthcare Provider Details

I. General information

NPI: 1659836195
Provider Name (Legal Business Name): DENEL FEQUIERE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 02/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORCHARD PARK DR
OCOEE FL
34761-7696
US

IV. Provider business mailing address

1800 ORCHARD PARK DR
OCOEE FL
34761-7696
US

V. Phone/Fax

Practice location:
  • Phone: 321-750-8913
  • Fax:
Mailing address:
  • Phone: 321-750-8913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberF260160794300
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: