Healthcare Provider Details

I. General information

NPI: 1639534100
Provider Name (Legal Business Name): FERNANDO GARCIA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4881 PALM BEACH BLVD STE 100
FORT MYERS FL
33905-3217
US

IV. Provider business mailing address

4881 PALM BEACH BLVD STE 100
FORT MYERS FL
33905-3217
US

V. Phone/Fax

Practice location:
  • Phone: 239-693-9191
  • Fax: 239-693-7369
Mailing address:
  • Phone: 239-693-9191
  • Fax: 239-693-7369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11006015
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: