MEDICARE: NEW BEGINNINGS AT FT MYERS LLC

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	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1235673849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW BEGINNINGS AT FT MYERS LLC

Provider Business Mailing Address
First Line	:	6202 PRESIDENTIAL CT
Second Line	:	SUITE E
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3563
Country	:	US
Telephone Number	:	813-766-2376
Fax Number	:

Provider Business Practice Location Address
First Line	:	6202 PRESIDENTIAL CT
Second Line	:	SUITE E
City	:	FORT MYERS
State	:	FL
Zip	:	33919-3563
Country	:	US
Telephone Number	:	813-766-2376
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIA A FUNDORA
Credential	:
Telephone Number	:	813-766-2376

Provider Enumeration Date	:	12/15/2016
Last Update Date	:	12/15/2016

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Directions to “NEW BEGINNINGS AT FT MYERS LLC ” Practice Location

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