Provider Demographics
NPI:1679082267
Name:NESBITT, AUDREY (LMT, MMP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:NESBITT
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20341 ESTERO GARDENS CIR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3464
Mailing Address - Country:US
Mailing Address - Phone:239-319-7511
Mailing Address - Fax:
Practice Address - Street 1:20341 ESTERO GARDENS CIR UNIT 103
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3464
Practice Address - Country:US
Practice Address - Phone:239-319-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA83107225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist