Healthcare Provider Details

I. General information

NPI: 1316428881
Provider Name (Legal Business Name): AILEEN CANCIO LEON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13279 N CLEVELAND AVE
NORTH FORT MYERS FL
33903-4818
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-652-4111
  • Fax: 239-652-4105
Mailing address:
  • Phone: 239-652-4111
  • Fax: 239-652-4105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME178429
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCBHCM101409
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: