Healthcare Provider Details

I. General information

NPI: 1154951234
Provider Name (Legal Business Name): JULIE MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9981 S HEALTHPARK DR STE 454
FORT MYERS FL
33908-3618
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-468-8041
  • Fax: 239-468-7953
Mailing address:
  • Phone: 239-468-8041
  • Fax: 239-468-7953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11046206
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP021138
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: