MEDICARE: ERICA ANNE STREETS ARNP

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	363LF0000X	Family Nurse Practitioner	ARNP 9326112	FL

General Provider Information

NPI Number	:	1255747390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA ANNE STREETS ARNP

Provider Business Mailing Address
First Line	:	4975 ROYAL GULF CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-7006
Country	:	US
Telephone Number	:	239-935-7876
Fax Number	:	239-935-7855

Provider Business Practice Location Address
First Line	:	4975 ROYAL GULF CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33966-7006
Country	:	US
Telephone Number	:	239-935-7876
Fax Number	:	239-935-7855

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

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	10/16/2015

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