Provider Demographics
NPI:1740077197
Name:SEMENOV, INESSA (FNP)
Entity type:Individual
Prefix:
First Name:INESSA
Middle Name:
Last Name:SEMENOV
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:INESSA
Other - Middle Name:
Other - Last Name:ATAYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34000 PORTOFINO CIR APT 112
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1280
Mailing Address - Country:US
Mailing Address - Phone:561-917-0226
Mailing Address - Fax:
Practice Address - Street 1:600 HERITAGE DR STE 210
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3097
Practice Address - Country:US
Practice Address - Phone:561-917-0226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11038516363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty