Provider Demographics
NPI:1164514105
Name:DWYER, NANCY H (ARNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:H
Last Name:DWYER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 NORTHBORO DR
Mailing Address - Street 2:UNIT #102
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-9043
Mailing Address - Country:US
Mailing Address - Phone:239-248-3063
Mailing Address - Fax:
Practice Address - Street 1:5150 TAMIAMI TRL N
Practice Address - Street 2:SUITE #201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2812
Practice Address - Country:US
Practice Address - Phone:239-263-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9205402363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY065SAMedicare ID - Type Unspecified