Provider Demographics
NPI:1003426883
Name:FENELON, NATASHA L (APRN)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:L
Last Name:FENELON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6675 WESTWOOD BLVD
Mailing Address - Street 2:STE 475
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0330
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:684 STATE ROAD 60 W
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4419
Practice Address - Country:US
Practice Address - Phone:863-949-4868
Practice Address - Fax:863-223-8549
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2022-03-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL11008419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily