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General NPI Number Information
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NPI Number | 1245949973
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Entity Type | Individual
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Provider Name | JANE LIZ DE LA VEGA FNP
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Gender | Female
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Dates
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Enumeration Date | 11/21/2022
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Last Update Date | 03/26/2023
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Provider Practice Location Address
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Address Line | 12781 WORLD PLAZA LN STE 1
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City | FORT MYERS
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State | FL
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Zip | 33907-4078
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Country | US
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Telephone | 239-848-9026
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Fax | 239-985-9024
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Provider Business Mailing Address
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Address Line | 225 SANTA BARBARA BLVD
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City | CAPE CORAL
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State | FL
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Zip | 33991-2032
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Country | US
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Telephone | 813-446-6230
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11023124
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License Number State | FL
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