Individual provider Active NPI

John A Fusselman, RN MSN FNP-C

  • Family Nurse Practitioner
  • Maitland, FL
National Provider Identifier
1336557032
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP126084 Issued in TX
Practice address
2600 Westhall LN
Maitland, FL 32751-7102
Phone
(361) 290-0009
NPI assigned
Jul 25, 2014
Last updated
Feb 1, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11023629 FL
Family Nurse Practitioner 363LF0000X AP126084 TX Primary

Addresses

Primary practice location

2600 Westhall LN
Maitland, FL 32751-7102

Mailing address

2600 Westhall LN
Maitland, FL 32751-7102
Phone (361) 290-0009

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151229001383 TX Practitioner - Nurse Practitioner 1052612520

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
11023629FLMDFamily Nurse Practitioner
AP126084TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Thomas-Spann Clinic, P.a. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1336557032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 WESTHALL LN",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517102",
            "telephone_number": "361-290-0009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 WESTHALL LN",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517102",
            "telephone_number": "361-290-0009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUSSELMAN",
        "first_name": "JOHN",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "RN MSN FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-25",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11023629",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP126084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

Verify at the official NPI Registry.