Provider Demographics
NPI:1215946058
Name:FEMENELLA, JOHN C (ARNP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:FEMENELLA
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13910 FIVAY RD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7154
Mailing Address - Country:US
Mailing Address - Phone:727-517-5852
Mailing Address - Fax:727-869-0958
Practice Address - Street 1:13910 FIVAY RD
Practice Address - Street 2:SUITE ONE
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-517-5852
Practice Address - Fax:727-869-0958
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1509132363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL762789100Medicaid