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General NPI Number Information
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NPI Number | 1093136509
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Entity Type | Organization
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Legal Business Name | FORT MYERS NURSING AGENCY
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Dates
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Enumeration Date | 12/31/2013
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 11220 METRO PKWY SUITE 19
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City | FORT MYERS
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State | FL
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Zip | 33966-1264
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Country | US
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Telephone | 239-277-1168
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Fax | 239-277-1201
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Provider Business Mailing Address
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Address Line | 11220 METRO PKWY SUITE 19
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City | FORT MYERS
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State | FL
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Zip | 33966-1264
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Country | US
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Telephone | 239-277-1168
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Fax | 239-277-1201
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JACQUELINE MARIE PAMPINELLA
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Credential |
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Telephone | 239-277-1168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299991096
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License Number State | FL
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