Healthcare Provider Details

I. General information

NPI: 1336858240
Provider Name (Legal Business Name): HOLLY ANN LENZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13681 DOCTORS WAY
FORT MYERS FL
33912-4300
US

IV. Provider business mailing address

420 SE 13TH PL
CAPE CORAL FL
33990-2627
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1000
  • Fax:
Mailing address:
  • Phone: 239-572-4743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9319831
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11037842
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: