Healthcare Provider Details

I. General information

NPI: 1275803827
Provider Name (Legal Business Name): JENNIFER LYNN FAIRBANK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W GORE ST STE 607
ORLANDO FL
32806-1051
US

IV. Provider business mailing address

8430 FOXWORTH CIR
ORLANDO FL
32819-5035
US

V. Phone/Fax

Practice location:
  • Phone: 407-210-1320
  • Fax: 321-202-2585
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9214030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: