Healthcare Provider Details

I. General information

NPI: 1275121790
Provider Name (Legal Business Name): ADELAIDA D ALFONSO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2021
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13691 METRO PKWY STE 110A
FORT MYERS FL
33912-4348
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 239-310-5303
  • Fax: 239-310-5304
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11008356
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: