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General NPI Number Information
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NPI Number | 1750752424
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Entity Type | Organization
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Legal Business Name | GULF COAST FAMILY CARE, PLC
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 10/07/2015
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Provider Practice Location Address
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Address Line | 814 SW PINE ISLAND RD SUITE 306
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City | CAPE CORAL
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State | FL
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Zip | 33991-1939
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Country | US
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Telephone | 239-829-0280
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Fax | 239-829-0315
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Provider Business Mailing Address
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Address Line | 814 SW PINE ISLAND RD SUITE 306
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City | CAPE CORAL
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State | FL
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Zip | 33991-1939
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Country | US
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Telephone | 239-829-0280
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Fax | 239-829-0315
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | DEBORAH WALKER
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Credential | ARNP
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Telephone | 239-829-0280
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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 | ARNP 2617642
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ARNP 2617642
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License Number State | FL
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