Healthcare Provider Details

I. General information

NPI: 1811058019
Provider Name (Legal Business Name): ELIZABETH ANN FEATHERSTONE P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 8TH ST N
NAPLES FL
34102-5519
US

IV. Provider business mailing address

3434 HANCOCK BRIDGE PKWY STE 301
NORTH FORT MYERS FL
33903-7094
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-3312
  • Fax: 239-430-5598
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-599-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9102103
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: