Healthcare Provider Details

I. General information

NPI: 1639936891
Provider Name (Legal Business Name): RACHELLE FIUZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 INTERWAY PL
ARLINGTON TX
76018-5668
US

IV. Provider business mailing address

1792 WILENE DR
BEAVERCREEK OH
45432-4017
US

V. Phone/Fax

Practice location:
  • Phone: 817-735-1180
  • Fax:
Mailing address:
  • Phone: 941-201-8178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG10230033
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAG10230033
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG10230033
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: