Healthcare Provider Details

I. General information

NPI: 1962643841
Provider Name (Legal Business Name): TULAY DARSTEK MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11181 HEALTH PARK BLVD SUITE 2260
NAPLES FL
34110-5738
US

IV. Provider business mailing address

11181 HEALTH PARK BLVD SUITE 2260
NAPLES FL
34110-5738
US

V. Phone/Fax

Practice location:
  • Phone: 239-514-5006
  • Fax: 239-514-5008
Mailing address:
  • Phone: 239-514-5006
  • Fax: 239-514-5008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME95721
License Number StateFL

VIII. Authorized Official

Name: DR. TULAY DARSTEK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 239-514-5006