Basic Information
| Provider Information | |||||||||
| NPI: | 1164704649 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCE MEDICAL OF NAPLES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 GOODLETTE RD N | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395667676 | ||||||||
| FaxNumber: | 2392543105 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 GOODLETTE RD N | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341025656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395667676 | ||||||||
| FaxNumber: | 2392543105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2011 | ||||||||
| LastUpdateDate: | 10/09/2014 | ||||||||
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| AuthorizedOfficialLastName: | MARTELL | ||||||||
| AuthorizedOfficialFirstName: | LORI-ANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2392543104 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LPN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.