Provider Demographics
NPI:1114665767
Name:GULF COAST COMPLETE HEALTH CARE
Entity Type:Organization
Organization Name:GULF COAST COMPLETE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEATON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:239-281-1982
Mailing Address - Street 1:2144 SAINT CROIX AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-2037
Mailing Address - Country:US
Mailing Address - Phone:239-281-1982
Mailing Address - Fax:
Practice Address - Street 1:2144 SAINT CROIX AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-2037
Practice Address - Country:US
Practice Address - Phone:239-281-1982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty