Healthcare Provider Details

I. General information

NPI: 1255001665
Provider Name (Legal Business Name): VANESSA NANK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15050 ELDERBERRY LN
FORT MYERS FL
33907-8504
US

IV. Provider business mailing address

15050 ELDERBERRY LN
FORT MYERS FL
33907-8504
US

V. Phone/Fax

Practice location:
  • Phone: 239-610-1552
  • Fax:
Mailing address:
  • Phone: 239-610-1552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1548
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: