Healthcare Provider Details

I. General information

NPI: 1205918547
Provider Name (Legal Business Name): JOANN R AGRESS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 OAK RIDGE CT STE 304
FORT MYERS FL
33901-9371
US

IV. Provider business mailing address

20410 TALON TRCE
ESTERO FL
33928-3028
US

V. Phone/Fax

Practice location:
  • Phone: 239-776-1855
  • Fax: 239-567-5620
Mailing address:
  • Phone: 239-776-1855
  • Fax: 239-567-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY0006587
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY0006587
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0006587
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: