Healthcare Provider Details

I. General information

NPI: 1649248493
Provider Name (Legal Business Name): ANNA J. MCCAUGHNA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8381 RIVERWALK PARK BLVD
FT MYERS FL
33919-8760
US

IV. Provider business mailing address

1821 JUNG BLVD E
NAPLES FL
34120-0486
US

V. Phone/Fax

Practice location:
  • Phone: 239-274-0005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9200234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: