Healthcare Provider Details

I. General information

NPI: 1568658383
Provider Name (Legal Business Name): KELLY JANE RIOS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2007
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3487 BROADWAY
FORT MYERS FL
33901-7213
US

IV. Provider business mailing address

3487 BROADWAY
FORT MYERS FL
33901-7213
US

V. Phone/Fax

Practice location:
  • Phone: 239-334-9555
  • Fax: 239-334-2832
Mailing address:
  • Phone: 239-334-9555
  • Fax: 239-334-2832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN9226866
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: