Healthcare Provider Details

I. General information

NPI: 1831487925
Provider Name (Legal Business Name): NICOLE PASCUAL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE KAUFFMAN, LONGTON ARNP

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 CAPE CORAL PKWY E
CAPE CORAL FL
33904
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-541-4420
  • Fax: 239-541-4421
Mailing address:
  • Phone: 239-541-4420
  • Fax: 239-541-4421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9227226
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9227226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: