Healthcare Provider Details

I. General information

NPI: 1831561489
Provider Name (Legal Business Name): MELISSA LOSIEWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9131 COLLEGE POINTE CT
FORT MYERS FL
33919-3245
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-9100
  • Fax: 239-343-9108
Mailing address:
  • Phone: 239-343-9100
  • Fax: 239-343-9108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704288027
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11007323
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: