Provider Demographics
NPI:1295016699
Name:BOYLE, COLETTA M (ARNP)
Entity Type:Individual
Prefix:
First Name:COLETTA
Middle Name:M
Last Name:BOYLE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:842 SUNSET LAKE BLVD
Practice Address - Street 2:SUITE 403, BUILDING B
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-7551
Practice Address - Country:US
Practice Address - Phone:941-485-3351
Practice Address - Fax:941-485-7677
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1153092363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9029745OtherAETNA
FL48186OtherUNIVERSAL HEALTHCARE
FLP00990542OtherRAILROAD MEDICARE
FL398532OtherAVMED
FLP937853OtherOPTIMUM
FLP997003OtherFREEDOM HEALTH
FL1224574OtherWELLCARE