Healthcare Provider Details

I. General information

NPI: 1740147024
Provider Name (Legal Business Name): DIDIET CORVEA LEDESMA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 EMBERS PKWY W FL USA
CAPE CORAL FL
33993-7634
US

IV. Provider business mailing address

1702 EMBERS PKWY W FL USA
CAPE CORAL FL
33993-7634
US

V. Phone/Fax

Practice location:
  • Phone: 786-389-4121
  • Fax:
Mailing address:
  • Phone: 786-389-4121
  • Fax: 786-389-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11044749
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: