Provider Demographics
NPI:1992134753
Name:KING, JANIS (APRN)
Entity type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:394-680-2852
Mailing Address - Fax:239-468-0288
Practice Address - Street 1:3501 HEALTH CENTER BLVD STE 2410
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34135-8131
Practice Address - Country:US
Practice Address - Phone:239-468-0285
Practice Address - Fax:239-468-0288
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9292097363LF0000X
CT5555363LF0000X
FLARNP9292097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3SC5WOtherBCBS
FLIP744ZOtherMEDICARE
FL017725800Medicaid
FL3SC5WOtherBCBS