Provider Demographics
NPI:1861963332
Name:INGALLS, AIMEE ROUTZONG (APRN)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:ROUTZONG
Last Name:INGALLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:CASSANDRA
Other - Last Name:ROUTZONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
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:239-343-9700
Mailing Address - Fax:239-343-9699
Practice Address - Street 1:8960 COLONIAL CENTER DR STE 302
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7810
Practice Address - Country:US
Practice Address - Phone:239-343-9700
Practice Address - Fax:239-343-9699
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-10
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9219654363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104082300Medicaid