Healthcare Provider Details

I. General information

NPI: 1679255780
Provider Name (Legal Business Name): JESSICA ROSARIO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8981 COLONIAL CENTER DR
FORT MYERS FL
33905-7816
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 239-938-0800
  • Fax: 866-420-0122
Mailing address:
  • Phone: 239-432-8500
  • Fax: 813-499-2658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11027692
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: