Healthcare Provider Details

I. General information

NPI: 1306242276
Provider Name (Legal Business Name): MS. NADINE MARIE WOINOSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3049 CLEVELAND AVE SUITE 269
FORT MYERS FL
33901-7041
US

IV. Provider business mailing address

1243 SLASH PINE CIR #124
PUNTA GORDA FL
33950-2292
US

V. Phone/Fax

Practice location:
  • Phone: 703-424-0354
  • Fax:
Mailing address:
  • Phone: 941-286-8897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1073871208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: