| Organization Name: | WEST COAST WELLNESS AND FAMILY MEDICINE PA |
| NPI Number: | 1013109974 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JESS HARRIS HAWKE (PRESIDENT) |
| Mailing Address: | 2512 Tamiami Trl N Nokomis |
| State: | FL US |
| Postal Code: | 342753476 |
| Phone Number: | 9419662342 |
| Fax Number: | 9419665864 |
| NPI Enumeration Date: | 08/15/2007 |
| NPI Last Update Date: | 09/11/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | OS-9654 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |