Provider Demographics
NPI:1902631948
Name:WILLIAMCEAU, JIMI
Entity type:Individual
Prefix:
First Name:JIMI
Middle Name:
Last Name:WILLIAMCEAU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15050 ELDERBERRY LN UNIT 6-10
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8504
Mailing Address - Country:US
Mailing Address - Phone:239-537-1260
Mailing Address - Fax:
Practice Address - Street 1:6900 DANIELS PKWY STE 23A
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1586
Practice Address - Country:US
Practice Address - Phone:239-349-3539
Practice Address - Fax:239-217-7469
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11035145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty