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General NPI Number Information
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NPI Number | 1629789177
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Entity Type | Individual
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Provider Name | ILKA FAWN SEPHUS APRN
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Gender | Female
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 10967 LAKE UNDERHILL RD STE 113
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City | ORLANDO
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State | FL
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Zip | 32825-4434
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Country | US
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Telephone | 833-769-3524
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Fax |
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Provider Business Mailing Address
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Address Line | 18324 BELLEZZA DR
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City | ORLANDO
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State | FL
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Zip | 32820-1451
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Country | US
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Telephone | 301-523-6414
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9367205
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11020697
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11020697
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License Number State | FL
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