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NPI Code Detail

MEDICARE: MRS. VICTORIA W FENTON PAC

MEDICARE: MRS. VICTORIA W FENTON PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA9110236FL
2363A00000XPhysician AssistantPA9110236FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093255333
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. VICTORIA W FENTON PAC
Provider Business Mailing Address
First Line : 1901 SE 18TH AVE STE 101
Second Line :
City : OCALA
State : FL
Zip : 34471-8211
Country : US
Telephone Number : 352-622-3360
Fax Number : 352-629-4512
Provider Business Practice Location Address
First Line : 1907 HIGHWAY 44 W
Second Line :
City : INVERNESS
State : FL
Zip : 34453-3801
Country : US
Telephone Number : 352-794-3897
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2017
Last Update Date : 01/04/2022

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Directions to “ MRS. VICTORIA W FENTON PAC” Practice Location

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