MEDICARE: KAYLA DIANE PUDLIN HARM APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	APRN11037047	FL
2	363LF0000X	Family Nurse Practitioner	APRN11037047	FL

General Provider Information

NPI Number	:	1164232625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA DIANE PUDLIN HARM APRN

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE STE 200
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9328
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3067 TAMIAMI TRL STE 4
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-6619
Country	:	US
Telephone Number	:	833-674-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	06/24/2026

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