MEDICARE: LOTY S. FALL 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	363LA2200X	Adult Health Nurse Practitioner	ARNP3105132	FL
2	363LF0000X	Family Nurse Practitioner	ARNP3105132	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3105132	OTHER	FL	ARNP LICENSE

General Provider Information

NPI Number	:	1609907898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOTY S. FALL ARNP

Provider Business Mailing Address
First Line	:	P.O. BOX 429
Second Line	:	COLLIER COUNTY HEALTH DEPARTMENT
City	:	NAPLES
State	:	FL
Zip	:	34106-0429
Country	:	US
Telephone Number	:	239-252-2697
Fax Number	:	239-774-5653

Provider Business Practice Location Address
First Line	:	3339 TAMIAMI TRL E
Second Line	:	SUITE 145
City	:	NAPLES
State	:	FL
Zip	:	34112-5361
Country	:	US
Telephone Number	:	239-252-2697
Fax Number	:	239-774-5653

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	02/06/2013

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Directions to “ LOTY S. FALL ARNP” Practice Location

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