Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | ARNP9251338 | FL |
NPI | 1033427638 |
---|---|
Provider Name | Jeannie Lane Coffey |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33901-5817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2010 |
Last Update Date | 04/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002752400 | (05) | FL |
Y05HV | BCBS (01) | FL |