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NPI Code Detail

MEDICARE: FREDERIC FAUGUE ARNP

MEDICARE: FREDERIC FAUGUE ARNP
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
1363L00000XNurse Practitioner9206289FL

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 : 1316312051
Entity Type Code : Individual
Provider Name (Legal Business Name) : FREDERIC FAUGUE ARNP
Provider Business Mailing Address
First Line : 1702 ACADIA HARBOR PL
Second Line :
City : BRANDON
State : FL
Zip : 33511-2304
Country : US
Telephone Number : 813-766-6955
Fax Number :
Provider Business Practice Location Address
First Line : 106 W WINDHORST RD
Second Line :
City : BRANDON
State : FL
Zip : 33510-2455
Country : US
Telephone Number : 813-373-9531
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2015
Last Update Date : 12/07/2015

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