Healthcare Provider Details

I. General information

NPI: 1801855424
Provider Name (Legal Business Name): FAYE ELLEN O'ROURKE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 KNOX MCRAE DR STE F
TITUSVILLE FL
32780-5492
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-269-2028
  • Fax: 321-264-0730
Mailing address:
  • Phone: 321-269-2028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9194778
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: