Provider Demographics
NPI:1376827709
Name:AVELLAN, EMMA R (FNP)
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:R
Last Name:AVELLAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16027 FAIRWAY LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1482
Mailing Address - Country:US
Mailing Address - Phone:781-492-9534
Mailing Address - Fax:
Practice Address - Street 1:9009 CORPORATE LAKE DR STE 200
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634
Practice Address - Country:US
Practice Address - Phone:954-226-9619
Practice Address - Fax:855-247-0930
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9407703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily