Provider Demographics
NPI:1316312051
Name:FAUGUE, FREDERIC (ARNP)
Entity type:Individual
Prefix:
First Name:FREDERIC
Middle Name:
Last Name:FAUGUE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:FREDERIC
Other - Middle Name:
Other - Last Name:FAUGUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:1702 ACADIA HARBOR PL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-2304
Mailing Address - Country:US
Mailing Address - Phone:813-766-6955
Mailing Address - Fax:
Practice Address - Street 1:106 W WINDHORST RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-2455
Practice Address - Country:US
Practice Address - Phone:813-373-9531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9206289363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner