Healthcare Provider Details

I. General information

NPI: 1477960888
Provider Name (Legal Business Name): DEETTA L DEPIRO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEETTA DEBAULT APRN

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 DEL PRADO BLVD N STE 104
CAPE CORAL FL
33909-2713
US

IV. Provider business mailing address

2675 WINKLER AVE STE 200
FORT MYERS FL
33901-9328
US

V. Phone/Fax

Practice location:
  • Phone: 239-573-1606
  • Fax: 239-573-1044
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN9277422
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: