Provider Demographics
NPI:1982949020
Name:MINK OF LEE COUNTY INC
Entity Type:Organization
Organization Name:MINK OF LEE COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:DENONTEVERDE
Authorized Official - Last Name:BURIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-574-8789
Mailing Address - Street 1:825 SANTA BARBARA BLVD.
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33995
Mailing Address - Country:US
Mailing Address - Phone:239-574-8789
Mailing Address - Fax:239-574-1883
Practice Address - Street 1:825 SANTA BARBARA BLVD.
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33995
Practice Address - Country:US
Practice Address - Phone:239-574-8789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2651042163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN2651042OtherR.N.