Provider Demographics
NPI:1902382898
Name:FOX, PEARL (ARNP)
Entity Type:Individual
Prefix:MS
First Name:PEARL
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 S KINGS AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5962
Mailing Address - Country:US
Mailing Address - Phone:813-872-4492
Mailing Address - Fax:813-490-9635
Practice Address - Street 1:403 S KINGS AVE STE 201
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5962
Practice Address - Country:US
Practice Address - Phone:813-872-4492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-14
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9319414363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily