Individual
DAVID FAWKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
1790 E VENICE AVE, SUITE 204, VENICE, FL 34292-3191
(941) 488-8884
(941) 488-5554
Mailing address
1790 E VENICE AVE, SUITE 204, VENICE, FL 34292-3191
(941) 488-8884
(941) 488-5554
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
ARNP1799382
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2080449
CIGNA
FL
01
—
283694-000
MAGELLAN
FL
05
—
304079800
—
FL
01
—
7305448
AETNA
FL
01
—
P00068887
RAILROAD MEDICARE
FL
01
—
Y7307
BCBS FLORIDA
FL
Enumeration date
09/26/2005
Last updated
02/08/2009
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