Healthcare Provider Details

I. General information

NPI: 1669658415
Provider Name (Legal Business Name): PELICAN BAY HEARING CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 TRAIL BLVD SUITE 16
NAPLES FL
34108-2880
US

IV. Provider business mailing address

5600 TRAIL BLVD SUITE 16
NAPLES FL
34108-2880
US

V. Phone/Fax

Practice location:
  • Phone: 239-566-2727
  • Fax: 239-463-7149
Mailing address:
  • Phone: 239-566-2727
  • Fax: 239-463-7149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY 77
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAY 77
License Number StateFL

VIII. Authorized Official

Name: MS. IRENA R RDZANEK
Title or Position: PRESIDENT
Credential:
Phone: 239-566-2727