Provider Demographics
NPI:1043898190
Name:FAST TRACK HEALTH LLC
Entity Type:Organization
Organization Name:FAST TRACK HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:RENEA
Authorized Official - Last Name:SMOKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:239-560-7363
Mailing Address - Street 1:2102 SE 10TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3277
Mailing Address - Country:US
Mailing Address - Phone:239-560-7363
Mailing Address - Fax:
Practice Address - Street 1:2102 SE 10TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3277
Practice Address - Country:US
Practice Address - Phone:239-322-2012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAST TRACK HEALTH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty