Individual
MRS. JACQUELINE BANNISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
6360 TECHSTER BLVD STE 1, FORT MYERS, FL 33966-4805
(239) 223-2751
Mailing address
6360 TECHSTER BLVD STE 1, FORT MYERS, FL 33966-4805
(239) 223-2751
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
ARNP9204616
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007338100
—
FL
Enumeration date
07/03/2012
Last updated
07/21/2022
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