Individual provider Active NPI

Sandra L Allen, APRN FNP-C

  • Family Nurse Practitioner
  • Fort Myers, FL
National Provider Identifier
1003475377
Registry record updated Feb 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11002345 Issued in FL
Practice address
4771 S Cleveland Ave
Fort Myers, FL 33907-1317
Phone
(239) 343-9800
Fax
(239) 343-9848
NPI assigned
Jun 11, 2019
Last updated
Feb 1, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 9387014 FL
Family Nurse Practitioner 363LF0000X APRN11002345 FL Primary

Addresses

Primary practice location

4771 S Cleveland Ave
Fort Myers, FL 33907-1317

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 343-9800

Other identifiers 1

IdentifierTypeStateIssuer
114923200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211014001914 FL Practitioner - Nurse Practitioner 1355749771 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
9387014FLMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Gulf Coast Healthcare Systems, Inc CurrentSince Feb 27, 2023 Accepting new patients
Gulf Coast Healthcare Systems Inc CurrentSince Feb 27, 2023 Accepting new patients

Locations

2724 5th St W
Ste Bc
Lehigh Acres, FL 33971
Phone (239) 303-9298

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675209600000",
    "number": "1003475377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-343-9800",
            "fax_number": "239-343-9848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4771 S CLEVELAND AVE",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071317",
            "telephone_number": "239-343-9800",
            "fax_number": "239-343-9848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLEN",
        "first_name": "SANDRA",
        "middle_name": "L",
        "credential": "APRN FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-11",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "9387014",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11002345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114923200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.