Healthcare Provider Details

I. General information

NPI: 1508603838
Provider Name (Legal Business Name): VANESSA ANNE GARZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA ANNE GARZA MFT

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3763 EVANS AVE
FORT MYERS FL
33901-9302
US

IV. Provider business mailing address

4957 EASTWOOD GREENS ST UNIT 107
FORT MYERS FL
33905-3743
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-3222
  • Fax: 239-332-0287
Mailing address:
  • Phone: 239-219-3744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT5037
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: