MEDICARE: FAYE ELLEN O'ROURKE APRN

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
1	363LF0000X	Family Nurse Practitioner	APRN9194778	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01847442	OTHER	FL	FL RR MEDICARE

General Provider Information

NPI Number	:	1801855424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAYE ELLEN O'ROURKE APRN

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-269-2028
Fax Number	:

Provider Business Practice Location Address
First Line	:	1855 KNOX MCRAE DR STE F
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-5492
Country	:	US
Telephone Number	:	321-269-2028
Fax Number	:	321-264-0730

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	05/08/2023

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