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General NPI Number Information
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NPI Number | 1164454963
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Entity Type | Individual
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Provider Name | KERRI POLLACK PA
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 8931 COLONIAL CENTER DR STE 400
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City | FORT MYERS
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State | FL
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Zip | 33905-7809
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Country | US
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Telephone | 239-334-6626
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Fax | 239-334-0404
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Provider Business Mailing Address
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Address Line | 4130 1ST AVE SW
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City | NAPLES
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State | FL
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Zip | 34119-2641
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Country | US
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Telephone | 516-263-4485
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9114481
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License Number State | FL
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