Charlotte Harbor Wellness P a

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

CHARLOTTE HARBOR WELLNESS P A

Practice address

2811 Tamiami TRL
Port Charlotte, FL 33952-5173

Phone

(941) 613-1919

Fax

(941) 613-4077

NPI assigned

Jun 23, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tetyana Metyk, MDNPI 1528354255

Title

Owner

Phone

(941) 613-1919

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tetyana Metyk, MD

  • Internal Medicine Physician
  • Port Charlotte, FL
  • NPI 1528354255
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687478400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1215613419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3191 HARBOR BLVD STE D",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339526755",
            "telephone_number": "941-613-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 TAMIAMI TRL",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339525173",
            "telephone_number": "941-613-1919",
            "fax_number": "941-613-4077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLOTTE HARBOR WELLNESS P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-23",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "METYK",
        "authorized_official_first_name": "TETYANA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-613-1919",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charlotte County Primary Care PA
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• Charlotte Family Dentistry LLC
• Charlotte Harbor Gastroenterology LLC
• Charlotte Harbor Rehab LLC
• Charlotte Health Center LLC
• Charlotte Health Solutions Inc
• Charlotte Hearing Center, Inc.
• Charlotte Heart & Vascular Center
• Charlotte Heart and Vascular Institute PA

• Internal Medicine Physician in Port Charlotte, FL
• Providers in Port Charlotte, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.