=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275996621
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSLYN OAKLEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2016
-----------------------------------------------------
Last Update Date | 03/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9350 CAMELOT DR
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33919-7980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-481-5437
-----------------------------------------------------
Fax | 239-481-0570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12730 NEW BRITTANY BLVD STE 602
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33907-4690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-275-5522
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 11603
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME156590
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------