Healthcare Provider Details

I. General information

NPI: 1144597881
Provider Name (Legal Business Name): SPECIALISTS IN REPRODUCTIVE MEDICINE & SURGERY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12611 WORLD PLAZA LN BUILDING 53
FORT MYERS FL
33907-3990
US

IV. Provider business mailing address

12611 WORLD PLAZA LN BUILDING 53
FORT MYERS FL
33907-3990
US

V. Phone/Fax

Practice location:
  • Phone: 239-275-8118
  • Fax: 239-275-5914
Mailing address:
  • Phone: 239-275-8118
  • Fax: 239-275-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberARNP9207683
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberME0060184
License Number StateFL

VIII. Authorized Official

Name: DR. CRAIG R. SWEET
Title or Position: PRESIDENT
Credential: M.D.
Phone: 239-275-8118