Provider Demographics
NPI:1932342144
Name:FOSNOT, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:FOSNOT
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 1:9741 LINGWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1881
Mailing Address - Country:US
Mailing Address - Phone:407-678-3349
Mailing Address - Fax:
Practice Address - Street 1:217 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4700
Practice Address - Country:US
Practice Address - Phone:407-260-0817
Practice Address - Fax:407-260-0817
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9708235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist