Provider Demographics
NPI:1649933169
Name:FENELUS, NANCY A
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:A
Last Name:FENELUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2028 SHEPHERD RD STE 207
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-8699
Mailing Address - Country:US
Mailing Address - Phone:321-330-7456
Mailing Address - Fax:
Practice Address - Street 1:4148 SALT SPRINGS LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33811-1892
Practice Address - Country:US
Practice Address - Phone:321-330-7456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor