MEDICARE: COLLEEN ELIZABETH SCUDDER 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	163WP0808X	Psychiatric/Mental Health Registered Nurse	ARNP 9242980	FL
2	363L00000X	Nurse Practitioner	ARNP9242980	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962450932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN ELIZABETH SCUDDER ARNP

Provider Business Mailing Address
First Line	:	P.O. BOX 2147
Second Line	:
City	:	FT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	239-424-1400
Fax Number	:	234-424-1421

Provider Business Practice Location Address
First Line	:	2776 CLEVELAND AVE
Second Line	:
City	:	FT MYERS
State	:	FL
Zip	:	33901-5864
Country	:	US
Telephone Number	:	239-334-5283
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	04/15/2009

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