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General NPI Number Information
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NPI Number | 1407235583
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Entity Type | Organization
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Legal Business Name | DRAKE FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 9143 BRENDAN PRESERVE CT
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-4376
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Country | US
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Telephone | 239-949-6888
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Fax | 239-949-0984
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Provider Business Mailing Address
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Address Line | PO BOX 2221
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City | BONITA SPRINGS
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State | FL
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Zip | 34133-2221
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Country | US
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Telephone | 239-949-6888
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Fax | 239-949-0984
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Authorized Official
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Title or Position | CEO
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Name | DR. KATIE ERIN DRAKE
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Credential | D.O.
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Telephone | 239-284-0416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS9565
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License Number State | FL
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