Provider Demographics
NPI:1073916029
Name:FRIED, JOELISSE MARIE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JOELISSE
Middle Name:MARIE
Last Name:FRIED
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:JOELISSE
Other - Middle Name:MARIE
Other - Last Name:MARRERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9400 TURKEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8001
Mailing Address - Country:US
Mailing Address - Phone:321-843-5500
Mailing Address - Fax:321-843-5550
Practice Address - Street 1:9400 TURKEY LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8001
Practice Address - Country:US
Practice Address - Phone:321-843-5500
Practice Address - Fax:321-843-5550
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9298804363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013636000Medicaid
FLARNP9298804OtherMEDICAL LICENSE
FLHZ426ZMedicare PIN