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General NPI Number Information
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NPI Number | 1588588925
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Entity Type | Organization
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Legal Business Name | LEGACY FAMILY CARE & WELLNESS LLC
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Dates
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Enumeration Date | 08/07/2026
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Last Update Date | 08/07/2026
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Provider Practice Location Address
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Address Line | 20791 TORRE DEL LAGO ST
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City | ESTERO
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State | FL
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Zip | 33928-6385
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Country | US
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Telephone | 239-240-0109
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Fax |
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Provider Business Mailing Address
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Address Line | 20791 TORRE DEL LAGO ST
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City | ESTERO
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State | FL
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Zip | 33928-6385
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/ OWNER
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Name | MARIE JAUNA MESIDOR
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Credential | APRN
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Telephone | 239-240-0109
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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 |
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License Number State |
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