Healthcare Provider Details

I. General information

NPI: 1750042131
Provider Name (Legal Business Name): MERCEDES LLAMA ESTEVEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 LEE BLVD STE 100
LEHIGH ACRES FL
33971-1569
US

IV. Provider business mailing address

PO BOX 3445
NORTH FORT MYERS FL
33918-3445
US

V. Phone/Fax

Practice location:
  • Phone: 239-369-3333
  • Fax: 239-369-4837
Mailing address:
  • Phone: 239-369-3333
  • Fax: 239-369-4837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11017436
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: