Healthcare Provider Details

I. General information

NPI: 1285185835
Provider Name (Legal Business Name): CAMEREN J HACKLEY ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 BUSINESS WAY SUITE 2
LEHIGH ACRES FL
33936-6073
US

IV. Provider business mailing address

8851 BOARDROOM CIR
FORT MYERS FL
33919-4888
US

V. Phone/Fax

Practice location:
  • Phone: 239-303-2600
  • Fax: 239-481-8150
Mailing address:
  • Phone: 239-481-7000
  • Fax: 239-433-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9445276
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: