Provider Demographics
NPI:1609907898
Name:FALL, LOTY S (ARNP)
Entity Type:Individual
Prefix:
First Name:LOTY
Middle Name:S
Last Name:FALL
Suffix:
Gender:F
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:P.O. BOX 429
Mailing Address - Street 2:COLLIER COUNTY HEALTH DEPARTMENT
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34106-0429
Mailing Address - Country:US
Mailing Address - Phone:239-252-2697
Mailing Address - Fax:239-774-5653
Practice Address - Street 1:3339 TAMIAMI TRL E
Practice Address - Street 2:SUITE 145
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-5361
Practice Address - Country:US
Practice Address - Phone:239-252-2697
Practice Address - Fax:239-774-5653
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3105132363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3105132OtherARNP LICENSE