Healthcare Provider Details

I. General information

NPI: 1841380623
Provider Name (Legal Business Name): MICHAEL S FRASURE ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 LAKESIDE VILLAGE LN
WINDERMERE FL
34786-7024
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 407-876-2273
  • Fax: 407-647-3850
Mailing address:
  • Phone: 407-876-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9173475
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: