Healthcare Provider Details

I. General information

NPI: 1760457956
Provider Name (Legal Business Name): JONATHAN F. ESCHEDOR ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7335 GLADIOLUS DR
FORT MYERS FL
33908-5101
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 239-689-6677
  • Fax: 239-939-0223
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9228334
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: