Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP3403802 | FL |
N | 363LN0000X | Nurse Practitioner - Neonatal | 3403802 | FL |
NPI | 1043754062 |
---|---|
Provider Name | Mrs. Peggy Sue Swann |
First Address | Fort Myers, FL 33903-5246 |
Second Address | Fort Myers, FL 33908-3618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2016 |
Last Update Date | 17/03/2018 |