Provider Demographics
NPI:1609802156
Name:FENN, ANN-MARIE (ARNP/LCSW)
Entity Type:Individual
Prefix:
First Name:ANN-MARIE
Middle Name:
Last Name:FENN
Suffix:
Gender:F
Credentials:ARNP/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 NW 83RD TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-3829
Mailing Address - Country:US
Mailing Address - Phone:352-275-8176
Mailing Address - Fax:
Practice Address - Street 1:6015 NW 83RD TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-3829
Practice Address - Country:US
Practice Address - Phone:352-275-8176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1577732363LX0001X
FLSW187121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340306800Medicaid