Provider Demographics
NPI:1366014086
Name:INTEGRATIVE DIRECT PRIMARY CARE, INC
Entity Type:Organization
Organization Name:INTEGRATIVE DIRECT PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:937-408-5058
Mailing Address - Street 1:4066 ASPEN CHASE DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8699
Mailing Address - Country:US
Mailing Address - Phone:937-408-5058
Mailing Address - Fax:
Practice Address - Street 1:2590 NORTHBROOKE PLAZA DR STE 106
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-8100
Practice Address - Country:US
Practice Address - Phone:239-350-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty