Individual
MYRIAM ST LOT COLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1350 LEE BLVD, LEHIGH ACRES, FL 33936-4846
(239) 369-2163
Mailing address
2346 DORA ST, FORT MYERS, FL 33901-5202
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
9538014
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03
—
FL
Enumeration date
03/18/2021
Last updated
03/18/2021
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