Healthcare Provider Details

I. General information

NPI: 1871048629
Provider Name (Legal Business Name): EILEEN THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
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: 239-468-7970
Mailing address:
  • Phone: 239-343-3552
  • Fax: 239-468-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114023
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9114023
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: