Provider Demographics
NPI:1003549692
Name:FEMMEWELL HOLDINGS LLC
Entity Type:Organization
Organization Name:FEMMEWELL HOLDINGS LLC
Other - Org Name:FEMMEWELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:862-216-0089
Mailing Address - Street 1:340 TOWN PLAZA AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5169
Mailing Address - Country:US
Mailing Address - Phone:904-395-5850
Mailing Address - Fax:904-395-5852
Practice Address - Street 1:340 TOWN PLAZA AVE STE 240
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5169
Practice Address - Country:US
Practice Address - Phone:904-395-5850
Practice Address - Fax:904-395-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty