Provider Demographics
NPI:1518065770
Name:NEILIO, JUDITH MARIE
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:MARIE
Last Name:NEILIO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JUDITH
Other - Middle Name:MARIE
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
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 1:310 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1800
Practice Address - Country:US
Practice Address - Phone:530-244-2223
Practice Address - Fax:530-244-4799
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN049313363LF0000X
CA20315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00977730OtherRAILROAD MEDICARE
CA9799772OtherAETNA
CA1518065770Medicaid
CAFJ268ZMedicare PIN