1497154785 NPI number — CHRISTINA MARIE CONCETTA FEOLA ARNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497154785 NPI number — CHRISTINA MARIE CONCETTA FEOLA ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEOLA
Provider First Name:
CHRISTINA
Provider Middle Name:
MARIE CONCETTA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497154785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8971 DANIELS CENTER DR
Provider Second Line Business Mailing Address:
UNIT 307
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33912-0310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-210-4247
Provider Business Mailing Address Fax Number:
239-210-4248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8971 DANIELS CENTER DR
Provider Second Line Business Practice Location Address:
UNIT 307
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33912-0310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-210-4247
Provider Business Practice Location Address Fax Number:
239-210-4248
Provider Enumeration Date:
08/22/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  ARNP9308403 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)