Provider Demographics
NPI:1346063617
Name:FERMIN, RENEE KELSIE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:KELSIE
Last Name:FERMIN
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 1:35260 SPRUCE KNOB CT
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-8718
Mailing Address - Country:US
Mailing Address - Phone:404-966-5201
Mailing Address - Fax:
Practice Address - Street 1:35260 SPRUCE KNOB CT
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-8718
Practice Address - Country:US
Practice Address - Phone:404-966-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant