Individual
MR. ARNOLD WILLIAM FACKLAM III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
5216 CLAYTON COURT, FORT MYERS, FL 33907
(239) 343-8260
(239) 343-8261
Mailing address
P.O. BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-8260
(239) 343-8261
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
APRN9420829
FL
363LF0000X
Family Nurse Practitioner
RN325609
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016126500
—
FL
01
—
J400001352
MEDICARE PTAN OBS ASSOCIATES U OF R
NY
Enumeration date
05/29/2008
Last updated
01/31/2024
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