Provider Demographics
NPI:1154790384
Name:BAUERLE, MATHEW J (ARNP)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:J
Last Name:BAUERLE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:315 E OLYMPIA AVE UNIT 223
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3823
Practice Address - Country:US
Practice Address - Phone:941-347-4588
Practice Address - Fax:941-205-2610
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9263086363LF0000X
FLAPRN9263086363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016264100Medicaid
FL4177906OtherAETNA
FL1395385OtherCIGNA
FLP01609951OtherRR MEDICARE
FLP972292OtherOPTIMUM
FLOJWBOOtherBCBS
FLP1036802OtherFREEDOM
FLIL767ZMedicare PIN