Healthcare Provider Details

I. General information

NPI: 1033020110
Provider Name (Legal Business Name): ARWEN FRYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 WILDWOOD LN
PALM COAST FL
32137-3221
US

IV. Provider business mailing address

36 WELLFORD LN
PALM COAST FL
32164-7865
US

V. Phone/Fax

Practice location:
  • Phone: 386-251-3350
  • Fax:
Mailing address:
  • Phone: 386-569-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2851396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: