Provider Demographics
NPI:1750752424
Name:GULF COAST FAMILY CARE, PLC
Entity type:Organization
Organization Name:GULF COAST FAMILY CARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:239-829-0280
Mailing Address - Street 1:814 SW PINE ISLAND RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-1939
Mailing Address - Country:US
Mailing Address - Phone:239-829-0280
Mailing Address - Fax:239-829-0315
Practice Address - Street 1:814 SW PINE ISLAND RD
Practice Address - Street 2:SUITE 306
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-1939
Practice Address - Country:US
Practice Address - Phone:239-829-0280
Practice Address - Fax:239-829-0315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2617642363LF0000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty