1487723581 NPI number — FLORIDA GULF COASTUNIVERSITY WELLNESS CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487723581 NPI number — FLORIDA GULF COASTUNIVERSITY WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLORIDA GULF COASTUNIVERSITY WELLNESS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487723581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9209 GARDEN POINTE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33908-3667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-432-9445
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
FLORIDA GULF COAST UNIVERSITY
Provider Second Line Business Practice Location Address:
10501 FGCU BOULEVARD S.
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33965-6565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-590-7868
Provider Business Practice Location Address Fax Number:
239-590-7968
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DONDORO
Authorized Official First Name:
EILEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR STUDENT HEALTH SERVICES
Authorized Official Telephone Number:
239-590-7868

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X , with the licence number:  ME25968 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com