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Individual

TINA MARIE FETALVO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DNP, NNP-BC

Contact information

Practice address
2 TAMPA GENERAL CIR, TAMPA, FL 33606-3571
(813) 821-8038
(813) 974-0483
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001

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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