Healthcare Provider Details

I. General information

NPI: 1114722204
Provider Name (Legal Business Name): VANESSA ASHLEY MAGLOIRE PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 08/23/2025
Certification Date: 08/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 BARCARMIL WAY
NAPLES FL
34110-0903
US

IV. Provider business mailing address

936 BARCARMIL WAY
NAPLES FL
34110-0903
US

V. Phone/Fax

Practice location:
  • Phone: 239-265-3391
  • Fax: 239-310-2035
Mailing address:
  • Phone: 239-265-3391
  • Fax: 239-310-2035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11037698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: