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General NPI Number Information
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NPI Number | 1871394155
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Entity Type | Organization
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Legal Business Name | PRIMECARE HEALTH GROUP LLC
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 15050 ELDERBERRY LN STE 6-10
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City | FORT MYERS
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State | FL
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Zip | 33907-8504
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Country | US
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Telephone | 239-537-1260
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Fax | 239-790-5073
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Provider Business Mailing Address
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Address Line | 15050 ELDERBERRY LN STE 6-10
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City | FORT MYERS
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State | FL
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Zip | 33907-8504
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Country | US
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Telephone | 239-537-1260
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Fax | 239-790-5073
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Authorized Official
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Title or Position | MEMBER
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Name | JIMI WILLIAMCEAU
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Credential | APRN
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Telephone | 239-537-1260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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