Provider Demographics
NPI:1700130721
Name:WOMEN'S HEALTHCARE OF SW FLORIDA, LLC
Entity Type:Organization
Organization Name:WOMEN'S HEALTHCARE OF SW FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARYLE
Authorized Official - Middle Name:LYNE
Authorized Official - Last Name:CLYATT
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:239-939-1999
Mailing Address - Street 1:7890 SUMMERLIN LAKES DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1851
Mailing Address - Country:US
Mailing Address - Phone:239-939-1999
Mailing Address - Fax:239-939-4935
Practice Address - Street 1:7890 SUMMERLIN LAKES DR
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1851
Practice Address - Country:US
Practice Address - Phone:239-939-1999
Practice Address - Fax:239-939-4935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92164207V00000X
FLME59299207V00000X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008470600Medicaid
FL008470600Medicaid