Individual
MR. NESLY ISMENARD CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
3822 BROADWAY STE A, FORT MYERS, FL 33901-8148
(239) 900-9170
Mailing address
1215 SEA PINES WAY, LANTANA, FL 33462-4248
(561) 574-5787
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
21-268
WI
363AM0700X
Medical Physician Assistant
Primary
10014
AZ
Other
Enumeration date
07/10/2023
Last updated
09/27/2024
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