MEDICARE: EMILIA DE JESUS CCP

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	242T00000X	Perfusionist	259163

General Provider Information

NPI Number	:	1922958776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILIA DE JESUS CCP

Provider Business Mailing Address
First Line	:	2250 MCGREGOR BLVD APT 3300
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-3477
Country	:	US
Telephone Number	:	239-264-1220
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 MCGREGOR BLVD APT 3300
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-3477
Country	:	US
Telephone Number	:	239-264-1220
Fax Number	:

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

Provider Enumeration Date	:	01/31/2026
Last Update Date	:	01/31/2026

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Directions to “ EMILIA DE JESUS CCP” Practice Location

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