Healthcare Provider Details

I. General information

NPI: 1508582933
Provider Name (Legal Business Name): ASHLEY RENEE FIDLER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 ALLIANCE LN STE 100
FORT MYERS FL
33912-7164
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1176
  • Fax: 239-468-7947
Mailing address:
  • Phone: 239-343-1176
  • Fax: 239-343-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberPA9116656
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9116656
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116656
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: