Healthcare Provider Details

I. General information

NPI: 1609131978
Provider Name (Legal Business Name): JACQUELINE WYNN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE HURLEY ARNP

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GOODLETTE RD N STE 340
NAPLES FL
34102-5412
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 239-206-1624
  • Fax:
Mailing address:
  • Phone: 877-856-3774
  • Fax: 239-599-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9282668
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: