Provider Demographics
NPI:1629693361
Name:OUELLETTE, ANITA GASTEL (APRN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:GASTEL
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:APRN
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Other - First Name:
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Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:8260 GLADIOLUS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4156
Practice Address - Country:US
Practice Address - Phone:239-437-5755
Practice Address - Fax:239-437-5776
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2021-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006204363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty