Healthcare Provider Details

I. General information

NPI: 1003510512
Provider Name (Legal Business Name): NICOLE SCHULTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 WINKLER AVE UNIT 270
FORT MYERS FL
33916-9581
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-3552
  • Fax:
Mailing address:
  • Phone: 239-343-3552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4783
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: