Healthcare Provider Details

I. General information

NPI: 1679531164
Provider Name (Legal Business Name): PREMIER MEDICAL STAFFING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 MEDICAL BLVD STE 101
NAPLES FL
34110-1426
US

IV. Provider business mailing address

1726 MEDICAL BLVD STE 101
NAPLES FL
34110-1426
US

V. Phone/Fax

Practice location:
  • Phone: 239-513-1992
  • Fax: 239-513-9022
Mailing address:
  • Phone: 239-513-1992
  • Fax: 239-513-9022

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 Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LESLIE C DAVIS
Title or Position: ASSISTANT MANAGER
Credential:
Phone: 239-513-1992