Healthcare Provider Details

I. General information

NPI: 1619711363
Provider Name (Legal Business Name): FLORIDA COMMUNITY HEALTH PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 COLLEGE PKWY STE 101
FORT MYERS FL
33919-5189
US

IV. Provider business mailing address

8140 COLLEGE PKWY STE 101
FORT MYERS FL
33919-5189
US

V. Phone/Fax

Practice location:
  • Phone: 239-202-8128
  • Fax:
Mailing address:
  • Phone: 239-202-8128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATIE JOHNSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 484-769-4369