Healthcare Provider Details

I. General information

NPI: 1851948707
Provider Name (Legal Business Name): LOURDES BETANCOURT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 07/31/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 9TH STREET NORTH SUITE 300
NAPLES FL
34102
US

IV. Provider business mailing address

399 9TH STREET NORTH SUITE 300
NAPLES FL
34102
US

V. Phone/Fax

Practice location:
  • Phone: 239-624-4200
  • Fax: 239-624-4241
Mailing address:
  • Phone: 239-624-4200
  • Fax: 239-624-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11003825
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: