Individual
CARLY LYNN HALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
13685 DOCTORS WAY STE 350, FORT MYERS, FL 33912-4347
(239) 343-3800
(239) 343-3993
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-3800
(239) 343-3993
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
11024184
FL
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN11024184
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117546100
—
FL
Enumeration date
02/02/2023
Last updated
03/20/2024
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