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811 Del Prado Blvd S Ste B Cape Coral FL 33990-2666 | |
| (239) 360-2634 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 811 Del Prado Blvd S Ste B, Cape Coral, Florida |
| Authorized Official Name and Position | Erica Chapman (MEMBER) |
| Authorized Official Contact | 2393602634 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
811 Del Prado Blvd S Ste B Cape Coral FL 33990-2666 Ph: (239) 360-2634 | 811 Del Prado Blvd S Ste B Cape Coral FL 33990-2666 Ph: (239) 360-2634 |
| NPI Number | 1720648355 |
|---|---|
| Provider Enumeration Date | 06/17/2019 |
| Last Update Date | 08/08/2024 |
| Medicare PECOS PAC ID | 3476885575 |
|---|---|
| Medicare Enrollment ID | O20191022003109 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720648355 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
| Provider Name | Cristin Nicole Wooten |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902289374 PECOS PAC ID: 1355642679 Enrollment ID: I20151210001454 |
| Provider Name | Victoria Rivera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912530809 PECOS PAC ID: 7012348964 Enrollment ID: I20200511001190 |
| Provider Name | Herbert Joseph Kalen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124699293 PECOS PAC ID: 2961896774 Enrollment ID: I20220221001881 |
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