Provider Demographics
NPI:1699286740
Name:ILE MYERS, RACHEL LYNN (ARNP-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:ILE MYERS
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4846 WALNUT CIR S
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2447
Mailing Address - Country:US
Mailing Address - Phone:863-860-0147
Mailing Address - Fax:
Practice Address - Street 1:14015 DANPARK LOOP
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-6854
Practice Address - Country:US
Practice Address - Phone:863-860-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9273487363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty