Healthcare Provider Details

I. General information

NPI: 1457451130
Provider Name (Legal Business Name): JO ANNE THERESA KOWALSKI A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17050 CORAL CAY LN
FORT MYERS FL
33908-5073
US

IV. Provider business mailing address

17050 CORAL CAY LN
FORT MYERS FL
33908-5073
US

V. Phone/Fax

Practice location:
  • Phone: 239-851-2800
  • Fax: 239-466-1367
Mailing address:
  • Phone: 239-851-2800
  • Fax: 239-466-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3224692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: