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General NPI Number Information
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NPI Number | 1114665767
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Entity Type | Organization
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Legal Business Name | GULF COAST COMPLETE HEALTH CARE
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 2144 SAINT CROIX AVE
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City | FORT MYERS
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State | FL
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Zip | 33905-2037
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Country | US
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Telephone | 239-281-1982
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Fax |
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Provider Business Mailing Address
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Address Line | 2144 SAINT CROIX AVE
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City | FORT MYERS
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State | FL
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Zip | 33905-2037
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Country | US
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Telephone | 239-281-1982
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | MELANIE DEATON
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Credential | NP
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Telephone | 239-281-1982
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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