Basic Information
| Provider Information | |||||||||
| NPI: | 1982789475 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCE MEDICAL OF NAPLES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1250 PINE RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341088913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395667676 | ||||||||
| FaxNumber: | 2392543405 | ||||||||
| Practice Location | |||||||||
| Address1: | 1250 PINE RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341088913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2395667676 | ||||||||
| FaxNumber: | 2392543105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 04/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | KRISHNA | ||||||||
| AuthorizedOfficialFirstName: | DEENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 2395667676 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | ARNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QH0100X | ARNP 9207692 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.