Healthcare Provider Details

I. General information

NPI: 1114837689
Provider Name (Legal Business Name): ADVENTHEALTH PORT CHARLOTTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25097 OLYMPIA AVE STE 107
PUNTA GORDA FL
33950-3914
US

IV. Provider business mailing address

PO BOX 931238
ATLANTA GA
31193-1238
US

V. Phone/Fax

Practice location:
  • Phone: 941-205-2620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER LAWRENCE
Title or Position: CFO
Credential:
Phone: 909-503-5223