Individual
ELLEN GORDON POAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
8660 COLLEGE PKWY, SUITE 60, FORT MYERS, FL 33919-4886
(239) 277-0919
(239) 415-4960
Mailing address
2234 COLONIAL BLVD, ATTN: PAYER CONTRACTING & RELATIONS, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP1812112
FL
363LF0000X
Family Nurse Practitioner
ARNP1812112
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235753
WELLCARE
FL
01
—
398633
AVMED
FL
01
—
5034309
AETNA
FL
01
—
P01279998
RAILROAD MCR
FL
01
—
P959926
OPTIMUM
FL
01
—
P999557
FREEDOM
FL
01
—
Y4971
BCBS OF FL
FL
Enumeration date
07/11/2007
Last updated
12/14/2016
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