Healthcare Provider Details

I. General information

NPI: 1760347173
Provider Name (Legal Business Name): JULIETTE PORTO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25241 ELEMENTARY WAY STE 102
BONITA SPRINGS FL
34135-7883
US

IV. Provider business mailing address

8700 BANYAN BAY BLVD
FORT MYERS FL
33908-8507
US

V. Phone/Fax

Practice location:
  • Phone: 239-301-2206
  • Fax:
Mailing address:
  • Phone: 786-613-0259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11043029
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: