Provider Demographics
NPI:1548447634
Name:PHELPS-KEATON, TUWANA FAYE (CNOR CRNFA)
Entity type:Individual
Prefix:MRS
First Name:TUWANA
Middle Name:FAYE
Last Name:PHELPS-KEATON
Suffix:
Gender:F
Credentials:CNOR CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5266
Mailing Address - Country:US
Mailing Address - Phone:352-253-3202
Mailing Address - Fax:
Practice Address - Street 1:1540 S TAMIAMI TRL STE 303
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2921
Practice Address - Country:US
Practice Address - Phone:941-917-8791
Practice Address - Fax:941-917-8793
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9290628163WR0006X
OHRN 225630163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant