Healthcare Provider Details

I. General information

NPI: 1093495459
Provider Name (Legal Business Name): CASEY RAY LANGFORD APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17595 S TAMIAMI TRL STE 211
FORT MYERS FL
33908-4889
US

IV. Provider business mailing address

17595 S TAMIAMI TRL STE 211
FORT MYERS FL
33908-4889
US

V. Phone/Fax

Practice location:
  • Phone: 941-254-1094
  • Fax: 239-790-0936
Mailing address:
  • Phone: 941-254-1094
  • Fax: 239-790-0936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11027632
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: