MEDICARE: JUDITH PETRIN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SG0600X	Gerontology Clinical Nurse Specialist	APRN1196972	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437146339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH PETRIN APRN

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-343-9220
Fax Number	:	239-343-9231

Provider Business Practice Location Address
First Line	:	12600 CREEKSIDE LN
Second Line	:	SUITE 7
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3353
Country	:	US
Telephone Number	:	239-343-9220
Fax Number	:	239-343-9231

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	10/07/2020

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Directions to “ JUDITH PETRIN APRN” Practice Location

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