Healthcare Provider Details

I. General information

NPI: 1982513883
Provider Name (Legal Business Name): JOANNA WITTCHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21300 S BRANCH BLVD
ESTERO FL
33928-9780
US

IV. Provider business mailing address

11908 BOURKE PL
FORT MYERS FL
33913-8491
US

V. Phone/Fax

Practice location:
  • Phone: 239-744-9866
  • Fax:
Mailing address:
  • Phone: 773-396-0620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: