Individual provider Active NPI

Mary Ann Komarynski, APRN

  • Clinical Nurse Specialist
  • Naples, FL
National Provider Identifier
1114114139
Registry record updated Mar 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Nurse SpecialistTaxonomy code 364S00000X
License
APRN9246232 Issued in FL
Practice address
3361 Pine Ridge Rd Ste 201
Naples, FL 34109-3938
Phone
(239) 254-4270
Fax
(239) 254-4271
NPI assigned
Oct 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Nurse Specialist 364S00000X APRN9246232 FL Primary

Addresses

Primary practice location

3361 Pine Ridge Rd Ste 201
Naples, FL 34109-3938

Mailing address

P.O. Box 2147
Fort Myers, FL 33902-2147
Phone (239) 254-4270

Other practice location 1

15901 Bass Rd
Suite 108
Fort Myers, FL 33908-3838
Phone (239) 343-6050

Other identifiers 1

IdentifierTypeStateIssuer
016080500MedicaidFL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mkomarynski92751@Direct.leememorial.org Lee Memorial Health System

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
APRN9246232FLMDClinical Nurse Specialist

Interoperability endpoints

  • Direct secure messaging: mkomarynski92751@direct.leememorial.org

NPI Registry JSON

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

{
    "created_epoch": "1191369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616976000000",
    "number": "1114114139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-254-4270",
            "fax_number": "239-254-4271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3361 PINE RIDGE RD STE 201",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341093938",
            "telephone_number": "239-254-4270",
            "fax_number": "239-254-4271"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15901 Bass Rd",
            "address_2": "Suite 108",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339083838",
            "country_code": "US",
            "telephone_number": "239-343-6050",
            "fax_number": "239-343-6051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOMARYNSKI",
        "first_name": "MARY",
        "middle_name": "ANN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-03",
        "last_updated": "2021-03-29",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "FL",
            "license": "APRN9246232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016080500",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkomarynski92751@Direct.leememorial.org",
            "affiliation": "Y",
            "affiliationName": "Lee Memorial Health System",
            "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 Naples, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.