Healthcare Provider Details

I. General information

NPI: 1558190967
Provider Name (Legal Business Name): ELIZABETH MARIE EADS DNP-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MARIE PIVAURNAS

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9980 SOUTH HEALTHPARK DRIVE
FORT MYERS FL
33908
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-6350
  • Fax:
Mailing address:
  • Phone: 239-343-6350
  • Fax: 239-343-4738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033305
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: