=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770606477
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PLANNED PARENTHOOD OF COLLIER COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1425 CREECH RD
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34103-4207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-262-8923
-----------------------------------------------------
Fax | 239-262-7658
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1425 CREECH RD
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34103-4207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-262-8923
-----------------------------------------------------
Fax | 239-262-7658
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AFFILIATE ADMINISTRATOR
-----------------------------------------------------
Name | MS. SUSAN STALLWOOD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-262-8923
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------