Provider Demographics
NPI:1710612239
Name:FONTA, PRINCEWILL (PMHNP)
Entity Type:Individual
Prefix:
First Name:PRINCEWILL
Middle Name:
Last Name:FONTA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 RICHARDSON LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-1232
Mailing Address - Country:US
Mailing Address - Phone:781-600-1703
Mailing Address - Fax:
Practice Address - Street 1:58 RICHARDSON LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-1232
Practice Address - Country:US
Practice Address - Phone:781-600-1703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL8-0010342363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health