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General NPI Number Information
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NPI Number | 1962458257
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Entity Type | Individual
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Provider Name | MANUEL JOHN SOUZA MS, ANP-BC
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 8350 RIVERWALK PARK BLVD STE 1
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City | FORT MYERS
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State | FL
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Zip | 33919-8759
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Country | US
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Telephone | 239-482-2663
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Fax | 239-482-7585
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Provider Business Mailing Address
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Address Line | 12670 CREEKSIDE LN STE 202
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City | FORT MYERS
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State | FL
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Zip | 33919-3370
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Country | US
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Telephone | 239-482-2663
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Fax | 239-482-7585
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 193850
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN9168451
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License Number State | FL
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