MEDICARE: DEETTA L DEPIRO 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	363LG0600X	Gerontology Nurse Practitioner	APRN9277422	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	:	1477960888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEETTA L DEPIRO APRN

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE STE 200
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9328
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 DEL PRADO BLVD N STE 104
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-2713
Country	:	US
Telephone Number	:	239-573-1606
Fax Number	:	239-573-1044

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

Provider Enumeration Date	:	07/17/2014
Last Update Date	:	05/08/2026

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1003899287 — MARSHALL D'SOUZA M.D.
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Practice Location Address:

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Directions to “ DEETTA L DEPIRO APRN” Practice Location

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