Healthcare Provider Details

I. General information

NPI: 1659148740
Provider Name (Legal Business Name): KAILA POLEON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAMPA GENERAL CIR
TAMPA FL
33606-3571
US

IV. Provider business mailing address

10501 FGCU BLVD S
FORT MYERS FL
33965-6502
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-7000
  • Fax:
Mailing address:
  • Phone: 239-590-7505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number158656
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: