Healthcare Provider Details

I. General information

NPI: 1215547310
Provider Name (Legal Business Name): PRIME MD OF NAPLES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 NORTHBROOKE PLAZA DR STE 200
NAPLES FL
34119-8088
US

IV. Provider business mailing address

2515 NORTHBROOKE PLAZA DR STE 200
NAPLES FL
34119-8088
US

V. Phone/Fax

Practice location:
  • Phone: 949-302-5644
  • Fax:
Mailing address:
  • Phone: 239-325-6955
  • Fax: 239-396-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. COSMINA ILEANA POPA
Title or Position: PHYSICIAN
Credential: MD
Phone: 239-325-6955