Provider Demographics
NPI:1801855424
Name:O'ROURKE, FAYE ELLEN (APRN)
Entity Type:Individual
Prefix:
First Name:FAYE
Middle Name:ELLEN
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-269-2028
Mailing Address - Fax:
Practice Address - Street 1:1855 KNOX MCRAE DR STE F
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-5492
Practice Address - Country:US
Practice Address - Phone:321-269-2028
Practice Address - Fax:321-264-0730
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9194778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01847442OtherFL RR MEDICARE