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General NPI Number Information
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NPI Number | 1972210102
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Entity Type | Organization
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Legal Business Name | PANIRA HEALTHCARE CLINIC, INC,
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 4975 TAMIAMI TRL E
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City | NAPLES
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State | FL
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Zip | 34113-4131
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Country | US
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Telephone | 239-529-5580
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Fax | 239-280-0264
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Provider Business Mailing Address
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Address Line | 4975 TAMIAMI TRL E
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City | NAPLES
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State | FL
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Zip | 34113-4131
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Country | US
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Telephone | 239-529-5580
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Fax | 239-280-0264
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Authorized Official
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Title or Position | COO
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Name | MARIE GENEVE MONGENE-EGGER
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Credential | RN/BSN
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Telephone | 239-529-5580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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