Individual
MARK THETFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13681 DOCTORS WAY, FORT MYERS, FL 33912-4300
(239) 343-1000
Mailing address
11131 EVERBLADES PKWY, ESTERO, FL 33928-9546
(618) 889-8220
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN9397749
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP9397749
FL
Other
Enumeration date
09/27/2017
Last updated
03/17/2018
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