Healthcare Provider Details

I. General information

NPI: 1386327872
Provider Name (Legal Business Name): PREMIER MOBILE MEDICAL CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10676 COLONIAL BLVD STE 20
FORT MYERS FL
33913-8715
US

IV. Provider business mailing address

10676 COLONIAL BLVD STE 20
FORT MYERS FL
33913-8715
US

V. Phone/Fax

Practice location:
  • Phone: 239-288-7949
  • Fax: 239-208-3944
Mailing address:
  • Phone: 239-288-7949
  • Fax: 239-208-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NADINE-ANNE ORINTHEA SINGH
Title or Position: OWNER
Credential: APRN
Phone: 239-288-7949