Healthcare Provider Details

I. General information

NPI: 1568604940
Provider Name (Legal Business Name): PROFESSIONAL RN FIRST ASSISTANTS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16295 S. TAMIAMI TRAIL #183
FORT MYERS FL
33908-5326
US

IV. Provider business mailing address

16295 S. TAMIAMI TRAIL #183
FORT MYERS FL
33908-5326
US

V. Phone/Fax

Practice location:
  • Phone: 239-433-0035
  • Fax: 239-267-5661
Mailing address:
  • Phone: 239-433-0035
  • Fax: 239-433-0035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN 1748502
License Number StateFL

VIII. Authorized Official

Name: JENNIFER J PAUL
Title or Position: OWNER/PROVIDER
Credential: RN CNDR CRNFA
Phone: 239-433-0035