Healthcare Provider Details

I. General information

NPI: 1609907898
Provider Name (Legal Business Name): LOTY S. FALL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3339 TAMIAMI TRL E SUITE 145
NAPLES FL
34112-5361
US

IV. Provider business mailing address

P.O. BOX 429 COLLIER COUNTY HEALTH DEPARTMENT
NAPLES FL
34106-0429
US

V. Phone/Fax

Practice location:
  • Phone: 239-252-2697
  • Fax: 239-774-5653
Mailing address:
  • Phone: 239-252-2697
  • Fax: 239-774-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP3105132
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3105132
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: