Individual
MS. KATHLEEN ELLEN MAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
7381 COLLEGE PKWY, SUITE 110, FORT MYERS, FL 33907-5548
(239) 482-1010
(239) 481-1481
Mailing address
13740 CYPRESS TERRACE CIR, FORT MYERS, FL 33907-8827
(239) 275-5522
(239) 275-4464
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP1343402
FL
363LF0000X
Family Nurse Practitioner
ARNP 1343402
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070980800
—
FL
05
—
303373200
—
FL
Enumeration date
08/11/2005
Last updated
08/04/2014
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