Provider Demographics
NPI:1366868291
Name:FORWARD, FONDA (CNA)
Entity Type:Individual
Prefix:
First Name:FONDA
Middle Name:
Last Name:FORWARD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5418 NW 20TH CT
Mailing Address - Street 2:APT B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-8120
Mailing Address - Country:US
Mailing Address - Phone:352-215-0475
Mailing Address - Fax:
Practice Address - Street 1:5418 NW 20TH CT
Practice Address - Street 2:APT B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-8120
Practice Address - Country:US
Practice Address - Phone:352-215-0475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL260658376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide