Healthcare Provider Details

I. General information

NPI: 1659676427
Provider Name (Legal Business Name): NICOLE J ALLEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8931 COLONIAL CENTER DR SUITE 300
FORT MYERS FL
33905-7809
US

IV. Provider business mailing address

4371 VERONICA S SHOEMAKER BLVD
FORT MYERS FL
33916-2216
US

V. Phone/Fax

Practice location:
  • Phone: 239-938-0800
  • Fax: 239-938-0888
Mailing address:
  • Phone: 239-274-8200
  • Fax: 239-278-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9220450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: