Provider Demographics
NPI:1528473592
Name:E. FESMIRE, CRNFA, LLC
Entity type:Organization
Organization Name:E. FESMIRE, CRNFA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNFA
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:FESMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNFA
Authorized Official - Phone:386-462-7346
Mailing Address - Street 1:10110 NW COUNTY ROAD 235
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-6660
Mailing Address - Country:US
Mailing Address - Phone:386-462-7346
Mailing Address - Fax:386-462-7381
Practice Address - Street 1:10110 NW COUNTY ROAD 235
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-6660
Practice Address - Country:US
Practice Address - Phone:386-462-7346
Practice Address - Fax:386-462-7381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN897992163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty