Healthcare Provider Details

I. General information

NPI: 1639854805
Provider Name (Legal Business Name): JASON ENSOR APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11181 HEALTH PARK BLVD STE 3010
NAPLES FL
34110-5743
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 239-302-3290
  • Fax: 239-302-3291
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11026853
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: