Provider Demographics
NPI:1861820235
Name:ECCLESIASTE, MURLA (ARNP)
Entity Type:Individual
Prefix:
First Name:MURLA
Middle Name:
Last Name:ECCLESIASTE
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:PO BOX 62707
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-2707
Mailing Address - Country:US
Mailing Address - Phone:239-931-3440
Mailing Address - Fax:
Practice Address - Street 1:1528 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3798
Practice Address - Country:US
Practice Address - Phone:239-458-3338
Practice Address - Fax:239-458-0666
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9271270363L00000X
FL9271270364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010403000Medicaid
FLY0L3VOtherFLORIDA BLUE
FL010403000Medicaid