Healthcare Provider Details

I. General information

NPI: 1447985932
Provider Name (Legal Business Name): NIOBET GERARDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 COLLEGE PKWY STE 107
FORT MYERS FL
33919-4111
US

IV. Provider business mailing address

3159 SUNSHINE BLVD N
LEHIGH ACRES FL
33971-4413
US

V. Phone/Fax

Practice location:
  • Phone: 239-360-7963
  • Fax: 239-360-7967
Mailing address:
  • Phone: 786-616-6269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-128326
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: