Healthcare Provider Details

I. General information

NPI: 1427408392
Provider Name (Legal Business Name): GINA MARIE VERNACE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16271 BASS RD
FORT MYERS FL
33908-3616
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-7100
  • Fax: 239-468-7924
Mailing address:
  • Phone: 239-343-7100
  • Fax: 239-468-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT017413
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS17672
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: