Provider Demographics
NPI:1518244375
Name:BREECE, JASON (ARNP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BREECE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:3571 DEL PRADO BLVD N STE 2
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-5287
Practice Address - Country:US
Practice Address - Phone:239-656-6300
Practice Address - Fax:239-656-6765
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9206384363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004353000Medicaid
FLY0H8QOtherFLORIDA BLUE
FL004353000Medicaid