Provider Demographics
NPI:1558697466
Name:WHALEN, PAMELA J (ARNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:WHALEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:J
Other - Last Name:SANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:311 9TH ST N STE 100
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5886
Mailing Address - Country:US
Mailing Address - Phone:239-624-8250
Mailing Address - Fax:239-430-7824
Practice Address - Street 1:350 7TH ST N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5754
Practice Address - Country:US
Practice Address - Phone:239-624-8250
Practice Address - Fax:239-624-8251
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9180733363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCQ205ZOtherMEDICARE
FLY01FSOtherBCBS
FL001781800Medicaid
FLCQ205ZMedicare PIN