| Ivan L Mazzorana Jr Md Pa | |
|
12590 Whitehall Dr Suite 3 Ft Myers FL 33907-3620 | |
| (239) 939-9090 | |
| (239) 939-2922 |
| Full Name | Ivan L Mazzorana Jr Md Pa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 12590 Whitehall Dr, Ft Myers, Florida |
| Authorized Official Name and Position | Ivan L Mazzorana (PRESIDENT) |
| Authorized Official Contact | 2399399090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivan L Mazzorana Jr Md Pa 12590 Whitehall Dr Suite 3 Ft Myers FL 33907-3620 Ph: (239) 939-9090 | Ivan L Mazzorana Jr Md Pa 12590 Whitehall Dr Suite 3 Ft Myers FL 33907-3620 Ph: (239) 939-9090 |
| NPI Number | 1790877488 |
|---|---|
| Provider Enumeration Date | 09/29/2006 |
| Last Update Date | 11/15/2012 |
| Medicare PECOS PAC ID | 5395647754 |
|---|---|
| Medicare Enrollment ID | O20040126000086 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790877488 | NPI | - | NPPES |
| 3189574 | Other | GHI | |
| 990014183 | Other | MEDICARE R.R. |
| Provider Name | Angela D Monterosso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558358556 PECOS PAC ID: 4082507629 Enrollment ID: I20040206000015 |
| Provider Name | Patricia Coccoma |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225032295 PECOS PAC ID: 8325058225 Enrollment ID: I20060421000147 |
| Provider Name | Ivan L Mazzorana |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669480653 PECOS PAC ID: 9830091297 Enrollment ID: I20070226000424 |
| Provider Name | Karen S Woods |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215162094 PECOS PAC ID: 7618029703 Enrollment ID: I20090721000578 |
| Provider Name | Kelly E Campbell-wigington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275813719 PECOS PAC ID: 7911165253 Enrollment ID: I20120216000231 |
| Provider Name | Karen L Brasile |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1184900045 PECOS PAC ID: 8527220771 Enrollment ID: I20120503000620 |
| Provider Name | Jeanette Bevilacqua |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083881684 PECOS PAC ID: 2264665215 Enrollment ID: I20140429001051 |
| Provider Name | Rebecca Esoldo |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1568529451 PECOS PAC ID: 0840593323 Enrollment ID: I20160115000821 |
| Provider Name | Karen S Stanley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558632430 PECOS PAC ID: 4486915386 Enrollment ID: I20180308002427 |
| Provider Name | James C Falduti |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174537666 PECOS PAC ID: 7911092341 Enrollment ID: I20180828003116 |
| Provider Name | Sharon Franco |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1316420839 PECOS PAC ID: 1355687559 Enrollment ID: I20190109000865 |
| Provider Name | Amanda B Ramos |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750944054 PECOS PAC ID: 4981938776 Enrollment ID: I20190627003034 |
| Provider Name | Katiana L Salinas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225540131 PECOS PAC ID: 2466886247 Enrollment ID: I20200103000251 |
| Provider Name | Tara N Howe |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568062719 PECOS PAC ID: 4981018207 Enrollment ID: I20210128000938 |
| Provider Name | Maylin Rodriguez Fernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528744950 PECOS PAC ID: 1557722535 Enrollment ID: I20230808000183 |
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