Provider Demographics
NPI:1093136509
Name:FORT MYERS NURSING AGENCY
Entity Type:Organization
Organization Name:FORT MYERS NURSING AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PAMPINELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-277-1168
Mailing Address - Street 1:11220 METRO PKWY
Mailing Address - Street 2:SUITE 19
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1264
Mailing Address - Country:US
Mailing Address - Phone:239-277-1168
Mailing Address - Fax:239-277-1201
Practice Address - Street 1:11220 METRO PKWY
Practice Address - Street 2:SUITE 19
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1264
Practice Address - Country:US
Practice Address - Phone:239-277-1168
Practice Address - Fax:239-277-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health