Healthcare Provider Details

I. General information

NPI: 1568391407
Provider Name (Legal Business Name): NURSE PRACTITIONER OWNED AND OPERATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 PASSAIC AVE
FORT MYERS FL
33901-6839
US

IV. Provider business mailing address

1430 PASSAIC AVE
FORT MYERS FL
33901-6839
US

V. Phone/Fax

Practice location:
  • Phone: 239-628-5238
  • Fax:
Mailing address:
  • Phone: 239-628-5238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAYANA ABRAHAM
Title or Position: FNP
Credential: FNP
Phone: 239-628-5238