Provider Demographics
NPI:1639690969
Name:CENEVIL, AMELIA ROSELINE
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:ROSELINE
Last Name:CENEVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 LEONE DR
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-8534
Mailing Address - Country:US
Mailing Address - Phone:863-353-8097
Mailing Address - Fax:
Practice Address - Street 1:1109 LEONE DR
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-8534
Practice Address - Country:US
Practice Address - Phone:863-353-8097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9280897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily