MEDICARE: NEXUS HEALTHCARE PA

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	367A00000X	Advanced Practice Midwife	1130652	FL
2	363LW0102X	Women's Health Nurse Practitioner	1130652	FL

General Provider Information

NPI Number	:	1841597820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEXUS HEALTHCARE PA

Provider Business Mailing Address
First Line	:	14548 CALUSA PALMS DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7769
Country	:	US
Telephone Number	:	941-313-9794
Fax Number	:	239-839-3319

Provider Business Practice Location Address
First Line	:	14548 CALUSA PALMS DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-7769
Country	:	US
Telephone Number	:	941-313-9794
Fax Number	:	239-839-3319

Authorized Official
Title or Position	:	OWNER
Name	:	MEEGAN D PAGE
Credential	:	ARNP
Telephone Number	:	941-313-9894

Provider Enumeration Date	:	02/28/2011
Last Update Date	:	06/18/2014

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1902286974 — DR. TERRY DORNAK PSY.D.
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Directions to “NEXUS HEALTHCARE PA ” Practice Location

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