Healthcare Provider Details

I. General information

NPI: 1932889250
Provider Name (Legal Business Name): ROGELIO DANIEL AVELAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2023
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 BONITA BEACH RD SE
BONITA SPRINGS FL
34135-4520
US

IV. Provider business mailing address

9071 BONITA BEACH RD SE STE 1389
BONITA SPRINGS FL
34135-4213
US

V. Phone/Fax

Practice location:
  • Phone: 239-434-8565
  • Fax: 239-799-4955
Mailing address:
  • Phone: 239-429-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11027541
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: