MEDICARE: TENDER HEART COUNSELING LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1992654339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TENDER HEART COUNSELING LLC

Provider Business Mailing Address
First Line	:	1950 COURTNEY DR STE 207
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9017
Country	:	US
Telephone Number	:	941-564-5265
Fax Number	:	239-282-4185

Provider Business Practice Location Address
First Line	:	1950 COURTNEY DR STE 207
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9017
Country	:	US
Telephone Number	:	941-564-5265
Fax Number	:	239-282-4185

Authorized Official
Title or Position	:	OWNER
Name	:	MARC THEODOR
Credential	:	PMHNP
Telephone Number	:	941-564-5265

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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Directions to “TENDER HEART COUNSELING LLC ” Practice Location

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