MEDICARE: NURSE PRACTITIONER OWNED AND OPERATED

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1568391407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSE PRACTITIONER OWNED AND OPERATED

Provider Business Mailing Address
First Line	:	1430 PASSAIC AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-6839
Country	:	US
Telephone Number	:	239-628-5238
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 PASSAIC AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-6839
Country	:	US
Telephone Number	:	239-628-5238
Fax Number	:

Authorized Official
Title or Position	:	FNP
Name	:	DAYANA ABRAHAM
Credential	:	FNP
Telephone Number	:	239-628-5238

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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