Healthcare Provider Details

I. General information

NPI: 1588588925
Provider Name (Legal Business Name): LEGACY FAMILY CARE & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20791 TORRE DEL LAGO ST
ESTERO FL
33928-6385
US

IV. Provider business mailing address

20791 TORRE DEL LAGO ST
ESTERO FL
33928-6385
US

V. Phone/Fax

Practice location:
  • Phone: 239-240-0109
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARIE JAUNA MESIDOR
Title or Position: NURSE PRACTITIONER/ OWNER
Credential: APRN
Phone: 239-240-0109