Healthcare Provider Details

I. General information

NPI: 1114114139
Provider Name (Legal Business Name): MARY ANN KOMARYNSKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 PINE RIDGE RD STE 201
NAPLES FL
34109-3938
US

IV. Provider business mailing address

P.O. BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-254-4270
  • Fax: 239-254-4271
Mailing address:
  • Phone: 239-254-4270
  • Fax: 239-254-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPRN9246232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: