Healthcare Provider Details

I. General information

NPI: 1548447634
Provider Name (Legal Business Name): TUWANA FAYE PHELPS-KEATON CNOR CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 S TAMIAMI TRL STE 303
SARASOTA FL
34239-2921
US

IV. Provider business mailing address

1000 WATERMAN WAY
TAVARES FL
32778-5266
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-8791
  • Fax: 941-917-8793
Mailing address:
  • Phone: 352-253-3202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN 9290628
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN 225630
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: