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General NPI Number Information
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NPI Number | 1972254266
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Entity Type | Individual
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Provider Name | GENOVEVA DE LA CRUZ JARA APRN
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Gender | Female
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 9470 HEALTHPARK CIR
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City | FORT MYERS
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State | FL
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Zip | 33908-3600
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Country | US
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Telephone | 239-482-4673
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Fax | 239-482-2659
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Provider Business Mailing Address
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Address Line | 4550 WINKLER AVE APT 104
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City | FORT MYERS
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State | FL
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Zip | 33966-7031
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Country | US
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Telephone | 239-465-2559
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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 | APRN11016535
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License Number State | FL
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