Healthcare Provider Details

I. General information

NPI: 1952359416
Provider Name (Legal Business Name): ELIZABETH ANN SCANLON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ELIZABETH ANN TIPTON

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 DEL PRADO BLVD. SUITE 103
CAPE CORAL FL
33990
US

IV. Provider business mailing address

12550 PROFESSIONAL PARK DR. SUITE 11
FORT MYERS FL
33913
US

V. Phone/Fax

Practice location:
  • Phone: 239-768-2111
  • Fax: 239-482-4404
Mailing address:
  • Phone: 239-768-2111
  • Fax: 239-482-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN3265172
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN3265172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: