Fasolo, Leah Marie

Fasolo, Leah Marie is an individual health care provider with primary practice located at 13340 Metro Pkwy Ste 200 , Fort Myers FL 33966-4818. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Gerontology. Physician Assistants & Advanced Practice Nursing Providers / Gerontology is her primary health care specialty. Fasolo, Leah Marie can be contacted via phone (239) 343-0550.

Contact Information

Primary practice address
13340 Metro Pkwy Ste 200 Fort Myers FL 33966-4818
Phone: (239) 343-0550
Fax: (239) 343-4013
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 9477790 Florida
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X APRN9477790 Florida

Profile Details

NPI number 1174992739
LBN Legal business name Fasolo, Leah Marie
Credentials APRN, ARNP
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 24th, 2015
Last updated Apr 1st, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174992739 NPPES
Florida MEDICAID 101880700

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