1619268547 NPI number — MRS. ERIN LAKE ARNP, FNP-BC

Table of content: MRS. ERIN LAKE ARNP, FNP-BC (NPI 1619268547)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619268547 NPI number — MRS. ERIN LAKE ARNP, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAKE
Provider First Name:
ERIN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROWAN
Provider Other First Name:
ERIN
Provider Other Middle Name:
CARTER
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619268547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2147
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33902-2147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-495-4490
Provider Business Mailing Address Fax Number:
239-495-4491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26800 S TAMIAMI TRL
Provider Second Line Business Practice Location Address:
SUITE 340
Provider Business Practice Location Address City Name:
BONITA SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34134-4349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-495-4490
Provider Business Practice Location Address Fax Number:
239-495-4491
Provider Enumeration Date:
04/26/2011

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: 363LF0000X , with the licence number:  ARNP9251206 , 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)

  • Identifier: 008708000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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