Provider Demographics
NPI:1902370901
Name:MCGOVERN, DAAD FATIMA (APRN)
Entity type:Individual
Prefix:MRS
First Name:DAAD
Middle Name:FATIMA
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5376 CORAL AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-5954
Mailing Address - Country:US
Mailing Address - Phone:239-699-6910
Mailing Address - Fax:
Practice Address - Street 1:5376 CORAL AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-5954
Practice Address - Country:US
Practice Address - Phone:239-699-6910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2214152363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health