1457783185 NPI number — DONNA MARIE FECHTMULLER ARNP

Table of content: DONNA MARIE FECHTMULLER ARNP (NPI 1457783185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457783185 NPI number — DONNA MARIE FECHTMULLER ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FECHTMULLER
Provider First Name:
DONNA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457783185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14075 OCEAN PINE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32828-7439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-305-2070
Provider Business Mailing Address Fax Number:
407-858-5523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
434 GROVE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-644-5567
Provider Business Practice Location Address Fax Number:
407-858-5999
Provider Enumeration Date:
08/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  ARNP9185263 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009602200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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