Individual
LEAH MARIE FASOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, ARNP
Contact information
Practice address
13340 METRO PKWY STE 200, FORT MYERS, FL 33966-4818
(239) 343-0550
(239) 343-4013
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-0550
(239) 343-4013
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
9477790
FL
363LG0600X
Gerontology Nurse Practitioner
Primary
APRN9477790
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101880700
—
FL
Enumeration date
09/24/2015
Last updated
04/01/2021
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