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General NPI Number Information
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NPI Number | 1003426883
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Entity Type | Individual
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Provider Name | NATASHA L FENELON APRN
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Gender | Female
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Dates
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Enumeration Date | 08/05/2020
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 684 STATE ROAD 60 W
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City | LAKE WALES
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State | FL
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Zip | 33853-4419
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Country | US
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Telephone | 863-949-4868
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Fax | 863-223-8549
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Provider Business Mailing Address
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Address Line | 6675 WESTWOOD BLVD STE 475
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City | ORLANDO
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State | FL
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Zip | 32821-6027
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Country | US
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Telephone | 407-845-0330
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Fax | 888-972-1752
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11008419
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License Number State | FL
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