Healthcare Provider Details

I. General information

NPI: 1295182269
Provider Name (Legal Business Name): IVAN DANKANICH ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
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 Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP9249134
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: