=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104143486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIP AMERICA OF SOUTHWEST FLORIDA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2010
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14440 METROPOLIS AVE STE 103
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33912-4364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-690-9969
-----------------------------------------------------
Fax | 239-690-9971
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2500 S KANNER HWY STE 3
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34994-4600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-220-6005
-----------------------------------------------------
Fax | 772-220-5867
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP OF OPERATIONS
-----------------------------------------------------
Name | ASHLEY SKIPPER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-220-6005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747A0650X
-----------------------------------------------------
Taxonomy Name | Attendant Care Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------