Provider Demographics
NPI:1255086385
Name:FOSTER, THEAWNA (DNP, APRN, NP-C)
Entity type:Individual
Prefix:DR
First Name:THEAWNA
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:DNP, APRN, NP-C
Other - Prefix:
Other - First Name:THEAWNA
Other - Middle Name:MARIE
Other - Last Name:TRISVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3928 S NOVA RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4911
Mailing Address - Country:US
Mailing Address - Phone:386-822-9941
Mailing Address - Fax:386-788-4519
Practice Address - Street 1:3928 S NOVA RD
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4911
Practice Address - Country:US
Practice Address - Phone:386-822-9941
Practice Address - Fax:386-788-4519
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11021203363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner