Healthcare Provider Details

I. General information

NPI: 1053093765
Provider Name (Legal Business Name): STEPHANIE WELLS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19531 COCHRAN BLVD
PORT CHARLOTTE FL
33948-2081
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 941-255-3535
  • Fax:
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11025883
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: