Healthcare Provider Details

I. General information

NPI: 1083523369
Provider Name (Legal Business Name): NAPLES FITNESS WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3960 RADIO RD STE 206
NAPLES FL
34104-3746
US

IV. Provider business mailing address

3960 RADIO RD STE 206
NAPLES FL
34104-3746
US

V. Phone/Fax

Practice location:
  • Phone: 239-293-7351
  • Fax:
Mailing address:
  • Phone: 239-293-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: IRENA BASNIKOVA
Title or Position: BOARD CERTIFIED HOLISTIC HEALTH
Credential: BCHHP, CPT,CPEP, LMT
Phone: 239-293-7351