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General NPI Number Information
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NPI Number | 1497413421
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Entity Type | Individual
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Provider Name | MORGAN FONVILLE APRN
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Gender | Female
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 11715 RANGELAND PKWY
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City | BRADENTON
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State | FL
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Zip | 34211-9529
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Country | US
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Telephone | 941-538-0001
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Fax | 941-538-0002
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Provider Business Mailing Address
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Address Line | 11715 RANGELAND PKWY
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City | BRADENTON
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State | FL
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Zip | 34211-9529
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Country | US
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Telephone | 941-958-0001
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Fax | 941-958-0002
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN11016879
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License Number State | FL
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