Provider Demographics
NPI:1619268547
Name:LAKE, ERIN (ARNP, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:LAKE
Suffix:
Gender:F
Credentials:ARNP, FNP-BC
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:CARTER
Other - Last Name:ROWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-495-4490
Mailing Address - Fax:239-495-4491
Practice Address - Street 1:26800 S TAMIAMI TRL
Practice Address - Street 2:SUITE 340
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4349
Practice Address - Country:US
Practice Address - Phone:239-495-4490
Practice Address - Fax:239-495-4491
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9251206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008708000Medicaid