Provider Demographics
NPI:1942937412
Name:SOUTH WEST FLORIDA COMPLETE HEALTHCARE LLC
Entity Type:Organization
Organization Name:SOUTH WEST FLORIDA COMPLETE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:239-738-8311
Mailing Address - Street 1:1781 FOUR MILE COVE PKWY UNIT 145
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2402
Mailing Address - Country:US
Mailing Address - Phone:239-738-8311
Mailing Address - Fax:239-778-9789
Practice Address - Street 1:1781 FOUR MILE COVE PKWY UNIT 145
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2402
Practice Address - Country:US
Practice Address - Phone:239-738-8311
Practice Address - Fax:239-778-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty