Individual
JENNY OTTOSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12600 CREEKSIDE LN STE 2, FORT MYERS, FL 33919-3353
(239) 343-9235
(239) 343-4008
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-9235
(239) 343-4008
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
12244
MN
363A00000X
Physician Assistant
Primary
PA9115206
FL
363AM0700X
Medical Physician Assistant
12244
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112821000
—
FL
Enumeration date
07/28/2016
Last updated
09/06/2023
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