Healthcare Provider Details

I. General information

NPI: 1851792147
Provider Name (Legal Business Name): DENYELLE LYN RISCASSI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2014
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 CLEVELAND AVE
FORT MYERS FL
33901-5858
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-3727
  • Fax: 239-343-2086
Mailing address:
  • Phone: 239-343-3332
  • Fax: 239-343-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN9167633
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: