MEDICARE: VANESSA NANK

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	103TS0200X	School Psychologist	SS1548	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SS1548	OTHER	FL	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255001665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA NANK

Provider Business Mailing Address
First Line	:	15050 ELDERBERRY LN
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-8504
Country	:	US
Telephone Number	:	239-610-1552
Fax Number	:

Provider Business Practice Location Address
First Line	:	15050 ELDERBERRY LN
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-8504
Country	:	US
Telephone Number	:	239-610-1552
Fax Number	:

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

Provider Enumeration Date	:	09/16/2021
Last Update Date	:	05/18/2026

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Directions to “ VANESSA NANK ” Practice Location

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