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General NPI Number Information
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NPI Number | 1568333011
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Entity Type | Organization
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Legal Business Name | FOXTROT WHISKEY TANGO LLC
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Dates
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Enumeration Date | 09/17/2025
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 12734 KENWOOD LN STE 79
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City | FORT MYERS
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State | FL
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Zip | 33907-5638
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Country | US
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Telephone | 239-970-4911
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Fax |
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Provider Business Mailing Address
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Address Line | 11939 AVALON PRESERVE BLVD
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City | FORT MYERS
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State | FL
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Zip | 33908-3679
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE NAVEGA
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Credential | LCSW
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Telephone | 239-970-4911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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