Healthcare Provider Details

I. General information

NPI: 1417492265
Provider Name (Legal Business Name): GULFCOAST FOOT AND ANKLE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 04/09/2024
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9915 TAMIAMI TRL N STE 1
NAPLES FL
34108-1927
US

IV. Provider business mailing address

PO BOX 110759
NAPLES FL
34108-0113
US

V. Phone/Fax

Practice location:
  • Phone: 239-566-8800
  • Fax: 239-566-8778
Mailing address:
  • Phone: 239-566-8800
  • Fax: 239-566-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3500
License Number StateFL

VIII. Authorized Official

Name: DR. BROOKE AUSTIN
Title or Position: OWNER
Credential: DPM
Phone: 239-949-3399