Healthcare Provider Details

I. General information

NPI: 1164019261
Provider Name (Legal Business Name): WELLCOMEMD NAPLES CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SW HEALTH PKWY STE 100
NAPLES FL
34109-0473
US

IV. Provider business mailing address

10001 PATTERSON AVE STE 202
RICHMOND VA
23238-5126
US

V. Phone/Fax

Practice location:
  • Phone: 239-597-0544
  • Fax: 877-500-8032
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JESSICA PARNELL
Title or Position: REGIONAL DIRECTOR OF PRACTICE MGMT
Credential:
Phone: 804-256-8205