Provider Demographics
NPI:1548625627
Name:NINO, ELIZABETH (FNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:NINO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 PINE RIDGE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-8927
Mailing Address - Country:US
Mailing Address - Phone:239-398-7454
Mailing Address - Fax:
Practice Address - Street 1:1110 PINE RIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-8927
Practice Address - Country:US
Practice Address - Phone:239-398-7454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9255879363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily