Healthcare Provider Details

I. General information

NPI: 1316659790
Provider Name (Legal Business Name): CHRISTOPHER JOHN LACOSSE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13681 DOCTORS WAY
FORT MYERS FL
33912-4300
US

IV. Provider business mailing address

13681 DOCTORS WAY
FORT MYERS FL
33912-4300
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number9530928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: