MEDICARE: YUDITH SIMON-CANELLAS FNP

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	364SF0001X	Family Health Clinical Nurse Specialist	ARNP 9400138	FL
2	363LF0000X	Family Nurse Practitioner	APRN9400138	FL

General Provider Information

NPI Number	:	1659738318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUDITH SIMON-CANELLAS FNP

Provider Business Mailing Address
First Line	:	1525 SE 5TH CT
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-2019
Country	:	US
Telephone Number	:	305-803-4502
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 SE 47TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33904-9692
Country	:	US
Telephone Number	:	239-205-2337
Fax Number	:	239-310-5287

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

Provider Enumeration Date	:	01/25/2016
Last Update Date	:	12/27/2021

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