Provider Demographics
NPI:1417252941
Name:VERFAILLIE, NABIHA (PA)
Entity Type:Individual
Prefix:
First Name:NABIHA
Middle Name:
Last Name:VERFAILLIE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2160 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3347 S STATE ROAD 7 STE 101
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8148
Practice Address - Country:US
Practice Address - Phone:561-790-2111
Practice Address - Fax:561-296-0436
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105708363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant