Healthcare Provider Details

I. General information

NPI: 1821716416
Provider Name (Legal Business Name): STEPHANIE NICOLE BLAKESLEE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE NICOLE LEWIS

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13681 DOCTORS WAY
FORT MYERS FL
33912-4300
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1000
  • Fax:
Mailing address:
  • Phone: 239-343-2052
  • Fax: 239-343-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11047941
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: