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Organization

FLORIDA GULF COAST UNIVERISTY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
PAULA NECOLE NEAL LAT (ASST. AD FOR HEALTH PERFORMANCE)
(239) 745-4299
Entity
Organization

Contact information

Practice address
10501 FGCU BLVD S, FORT MYERS, FL 33965-6502
(239) 742-4299
(239) 590-7398
Mailing address
10501 FGCU BLVD S, FORT MYERS, FL 33965-6502
(239) 742-4299
(239) 590-7398

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2255A2300X
Athletic Trainer

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
ME80216
STATE LICENSE
FL
Enumeration date
07/22/2020
Last updated
09/29/2020
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