MEDICARE: JEANNINE CATHERINE HEISS WUNDERLICH CRNA

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	367500000X	Certified Registered Nurse Anesthetist	ARNP2811442	FL

General Provider Information

NPI Number	:	1356662944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNINE CATHERINE HEISS WUNDERLICH CRNA

Provider Business Mailing Address
First Line	:	14013 CLEAR WATER LN
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-8097
Country	:	US
Telephone Number	:	239-281-4627
Fax Number	:

Provider Business Practice Location Address
First Line	:	6820 INTERNATIONAL CENTER BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-7129
Country	:	US
Telephone Number	:	239-360-8000
Fax Number	:

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	01/19/2021

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