Healthcare Provider Details

I. General information

NPI: 1326021239
Provider Name (Legal Business Name): PHYSICIANS PRIMARY CARE OF SOUTHWEST FLORIDA PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 VISCAYA PKWY STE 101
CAPE CORAL FL
33990-3252
US

IV. Provider business mailing address

12730 NEW BRITTANY BLVD STE 602
FORT MYERS FL
33907-4690
US

V. Phone/Fax

Practice location:
  • Phone: 239-573-7337
  • Fax: 239-574-5883
Mailing address:
  • Phone: 239-275-5522
  • Fax: 239-275-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JON BURDZY
Title or Position: MANAGING PHYSICIAN
Credential: DO
Phone: 239-275-5522