Provider Demographics
NPI:1487723581
Name:FLORIDA GULF COASTUNIVERSITY WELLNESS CENTER
Entity type:Organization
Organization Name:FLORIDA GULF COASTUNIVERSITY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR STUDENT HEALTH SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONDORO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:239-590-7868
Mailing Address - Street 1:9209 GARDEN POINTE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3667
Mailing Address - Country:US
Mailing Address - Phone:239-432-9445
Mailing Address - Fax:
Practice Address - Street 1:FLORIDA GULF COAST UNIVERSITY
Practice Address - Street 2:10501 FGCU BOULEVARD S.
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33965-6565
Practice Address - Country:US
Practice Address - Phone:239-590-7868
Practice Address - Fax:239-590-7968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME25968261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54478Medicare UPIN