Healthcare Provider Details

I. General information

NPI: 1316631823
Provider Name (Legal Business Name): COASTAL WOMEN'S WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13782 PLANTATION RD STE 102
FORT MYERS FL
33912-4462
US

IV. Provider business mailing address

13782 PLANTATION RD STE 102
FORT MYERS FL
33912-4462
US

V. Phone/Fax

Practice location:
  • Phone: 239-237-5529
  • Fax: 239-396-2118
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIN WARD
Title or Position: OWNER
Credential: MD
Phone: 410-967-6419