Provider Demographics
NPI:1225095649
Name:GOVENDER, SHIRLEY (ARNP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:GOVENDER
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9180
Mailing Address - Fax:239-343-9188
Practice Address - Street 1:12550 NEW BRITTANY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3655
Practice Address - Country:US
Practice Address - Phone:239-343-9180
Practice Address - Fax:239-343-9188
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2792562163W00000X, 363L00000X
FLAPRN2792562363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018228600Medicaid
FLY0972OtherBCBS
FLE6320TMedicare PIN