Provider Demographics
NPI:1851931398
Name:URSITTI, CARMEN
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:URSITTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-6341
Mailing Address - Fax:239-343-6342
Practice Address - Street 1:708 DEL PRADO BLVD S STE 14
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5616
Practice Address - Country:US
Practice Address - Phone:239-343-3727
Practice Address - Fax:239-343-2086
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115155100Medicaid