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General NPI Number Information
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NPI Number | 1972003499
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Entity Type | Individual
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Provider Name | SAN WONG APRN
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Gender | Male
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Dates
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Enumeration Date | 02/21/2018
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Last Update Date | 07/02/2024
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Provider Practice Location Address
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Address Line | 8380 RIVERWALK PARK BLVD STE 100
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City | FORT MYERS
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State | FL
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Zip | 33919-8758
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Country | US
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Telephone | 239-343-9960
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2147
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City | FORT MYERS
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State | FL
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Zip | 33902-2147
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Country | US
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Telephone | 239-343-3800
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Fax | 232-343-3993
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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 | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | APRN9232935
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License Number State | FL
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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 | APRN9232935
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License Number State | FL
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