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Individual
TINA MARIE FETALVO
Active
Individual
TINA MARIE FETALVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, NNP-BC
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
11034098
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123320000
—
FL
01
—
TLOWT
BLUE CROSS BLUE SHIELD
FL
Enumeration date
07/17/2024
Last updated
12/03/2024
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