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General NPI Number Information
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NPI Number | 1588311914
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL MEDICINE APRN LLC
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Dates
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Enumeration Date | 03/05/2022
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 7385 RADIO RD STE 104
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City | NAPLES
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State | FL
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Zip | 34104-6705
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Country | US
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Telephone | 239-601-4659
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Fax |
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Provider Business Mailing Address
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Address Line | 3700 GOLDEN GATE BLVD W
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City | NAPLES
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State | FL
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Zip | 34120-3043
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Country | US
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Telephone | 239-601-4659
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHY VERDES
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Credential | APRN
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Telephone | 239-601-4659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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