Healthcare Provider Details

I. General information

NPI: 1033748041
Provider Name (Legal Business Name): LIANET ESTHER COELLO BLANCO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 WINKLER AVE # 1
FORT MYERS FL
33901-9338
US

IV. Provider business mailing address

3514 NW 15TH ST
CAPE CORAL FL
33993-2506
US

V. Phone/Fax

Practice location:
  • Phone: 239-347-0810
  • Fax:
Mailing address:
  • Phone: 786-925-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11006473
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: