Healthcare Provider Details

I. General information

NPI: 1679788731
Provider Name (Legal Business Name): JOANNE FRANCES RUOT WORLEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13981 MCGREGOR BLVD PACAYA BAY SURGICAL CENTER
FORT MYERS FL
33919-6130
US

IV. Provider business mailing address

10505 BELLA VISTA DR
FORT MYERS FL
33913-7005
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-4505
  • Fax:
Mailing address:
  • Phone: 239-768-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number438772
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: