Individual provider Active NPI

Nabila Khan

  • Family Medicine Physician
  • Fort Myers, FL
National Provider Identifier
1104568088
Registry record updated Aug 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS22646 Issued in FL
Practice address
2780 Cleveland Ave Ste 709
Fort Myers, FL 33901-5857
Phone
(239) 343-3831
Fax
(239) 343-2301
NPI assigned
Apr 11, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS22646 FL Primary

Addresses

Primary practice location

2780 Cleveland Ave Ste 709
Fort Myers, FL 33901-5857

Mailing address

PO Box 2147
Fort Myers, FL 33902-2147
Phone (239) 343-3831

Other practice location 1

22250 Providence Dr Ste 557
Southfield, MI 48075-6213
Phone (248) 849-3447

Other identifiers 1

IdentifierTypeStateIssuer
127813800MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address nkhan675595@Direct.leememorial.org Direct LEE HEALTH SYSTEM INC

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250805000933 FL Practitioner - Family Practice 3577943620 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lee Health System IncGroup PAC ID 9335672146, 1,381 clinicians

Practice addresses (Care Compare)

2780 Cleveland Ave
Fort Myers, FL 33901-5858
Phone (239) 343-2686

Hospital & facility affiliations

  • Lee Memorial Hospital Hospital, Fort Myers, FL, CCN 100012
  • Cape Coral Hospital Hospital, Cape Coral, FL, CCN 100244

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles (2 of 3)

OrganizationSpecialtyStatusNew patients
Lee Health System Inc Family Medicine CurrentSince Aug 1, 2025 Accepting new patients
Lee Health System Inc CurrentSince Aug 1, 2025 Accepting new patients

Locations

1138 Country Club Blvd
Cape Coral, FL 33990
Phone (239) 424-1900

2776 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 343-2000

2780 Cleveland Ave
Fort Myers, FL 33901
Phone (239) 334-5454

2780 Cleveland Ave
Ste 709
Fort Myers, FL 33901
Phone (239) 343-2551

Networks

  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: nkhan675595@direct.leememorial.org

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 and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754438400000",
    "number": "1104568088",
    "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": "239-343-3831",
            "fax_number": "239-343-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2780 CLEVELAND AVE STE 709",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339015857",
            "telephone_number": "239-343-3831",
            "fax_number": "239-343-2301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22250 Providence Dr Ste 557",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480756213",
            "country_code": "US",
            "telephone_number": "248-849-3447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHAN",
        "first_name": "NABILA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-11",
        "last_updated": "2025-08-06",
        "certification_date": "2025-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS22646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127813800",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nkhan675595@Direct.leememorial.org",
            "affiliation": "Y",
            "affiliationName": "LEE HEALTH SYSTEM INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2776 Cleveland Ave",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339015864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.