Healthcare Provider Details

I. General information

NPI: 1255086385
Provider Name (Legal Business Name): THEAWNA FOSTER DNP, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THEAWNA MARIE TRISVAN

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GATEWAY CTR STE 2600
NEWARK NJ
07102-5323
US

IV. Provider business mailing address

111 N ORANGE AVE STE 800
ORLANDO FL
32801-2381
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 888-731-8894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11021203
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: