Provider Demographics
NPI:1184402752
Name:RENE, FABIENNE ROCHER (ARNP)
Entity type:Individual
Prefix:
First Name:FABIENNE
Middle Name:ROCHER
Last Name:RENE
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 1:1543 KINGSLEY AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4583
Mailing Address - Country:US
Mailing Address - Phone:904-264-0770
Mailing Address - Fax:
Practice Address - Street 1:1543 KINGSLEY AVE STE 3
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4583
Practice Address - Country:US
Practice Address - Phone:904-264-0770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily