MEDICARE: CAMEREN J HACKLEY 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	ARNP9445276	FL

General Provider Information

NPI Number	:	1285185835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMEREN J HACKLEY ARNP

Provider Business Mailing Address
First Line	:	8851 BOARDROOM CIR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-4888
Country	:	US
Telephone Number	:	239-481-7000
Fax Number	:	239-433-8999

Provider Business Practice Location Address
First Line	:	1220 BUSINESS WAY
Second Line	:	SUITE 2
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-6073
Country	:	US
Telephone Number	:	239-303-2600
Fax Number	:	239-481-8150

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

Provider Enumeration Date	:	10/19/2016
Last Update Date	:	10/19/2016

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