Individual
MR. MANUEL JOHN SOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ANP-BC
Contact information
Practice address
8350 RIVERWALK PARK BLVD STE 1, FORT MYERS, FL 33919-8759
(239) 482-2663
(239) 482-7585
Mailing address
12670 CREEKSIDE LN STE 202, FORT MYERS, FL 33919-3370
(239) 482-2663
(239) 482-7585
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
193850
MA
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN9168451
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
303290600
—
FL
01
—
500018529
RAIL ROAD MEDICARE
—
01
—
Y9368
BLUE SHIELD
FL
Enumeration date
05/26/2006
Last updated
05/09/2025
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