Individual provider Active NPI

Laurie J Desouza, ARNP

  • Nurse Practitioner
  • Fort Myers, FL
National Provider Identifier
1487872826
Registry record updated Dec 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
ARNP1352572 Issued in FL
Practice address
13813 Metro Pkwy
Fort Myers, FL 33912-4343
Phone
(239) 936-1343
Fax
(239) 936-8507
NPI assigned
Apr 23, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X ARNP1352572 FL Primary

Addresses

Primary practice location

13813 Metro Pkwy
Fort Myers, FL 33912-4343

Mailing address

PO Box 62707
Fort Myers, FL 33906-2707
Phone (239) 931-3440

Other identifiers 2

IdentifierTypeStateIssuer
009264900MedicaidFL
Y8493OtherFLFLORIDA BLUE

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
I20051018000362 FL Practitioner - Nurse Practitioner 3072539204 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physician Group LLC CurrentSince Jul 1, 2018 Accepting new patients
Millennium Physician Group LLC CurrentSince Jul 1, 2018 Accepting new patients
Internal Medicine Associates of Lee County Hospitalist Group, LLC Past Accepting new patients
Nancy M Troast DO PA PastSince May 25, 1998 Accepting new patients

Locations

24600 S Tamiami Trl
Ste 400
Bonita Springs, FL 34134
Phone (239) 948-3761

13813 Metro Pkwy
Fort Myers, FL 33912
Phone (239) 936-1343

13691 Metro Pkwy
Ste 130
Fort Myers, FL 33912
Phone (239) 349-3539

2675 Winkler Ave
Fl 2
Fort Myers, FL 33901
Phone (855) 979-5700

3434 Hancock Bridge Pkwy
Ste 301
North Ft Myers, FL 33903
Phone 877856377411108

4130 Tamiami Trl
Unit 100
Pt Charlotte, FL 33952
Phone (941) 629-4500

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

809 E Marion Ave
Punta Gorda, FL 33950
Phone (941) 625-1951

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480896000000",
    "number": "1487872826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 62707",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339062707",
            "telephone_number": "239-931-3440",
            "fax_number": "239-931-3458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13813 METRO PKWY",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124343",
            "telephone_number": "239-936-1343",
            "fax_number": "239-936-8507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESOUZA",
        "first_name": "LAURIE",
        "middle_name": "J",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-23",
        "last_updated": "2016-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "ARNP1352572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009264900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "Y8493",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.