Provider Demographics
NPI:1902673148
Name:LEE, SARAH LUCIA (CNM)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LUCIA
Last Name:LEE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 EICHEN CIR E
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-2519
Mailing Address - Country:US
Mailing Address - Phone:850-294-0256
Mailing Address - Fax:
Practice Address - Street 1:9021 PARK ROYAL DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9617
Practice Address - Country:US
Practice Address - Phone:239-432-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-07
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029669367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife