Healthcare Provider Details

I. General information

NPI: 1851931398
Provider Name (Legal Business Name): CARMEN URSITTI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 DEL PRADO BLVD S STE 14
CAPE CORAL FL
33990-5616
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-3727
  • Fax: 239-343-2086
Mailing address:
  • Phone: 239-343-6341
  • Fax: 239-343-6342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11005277
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: