MEDICARE: OKEECHOBEE WOUND AND WELLNESS CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	261QP2300X	Primary Care Clinic/Center
3	163WW0000X	Wound Care Registered Nurse

General Provider Information

NPI Number	:	1326913674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKEECHOBEE WOUND AND WELLNESS CLINIC

Provider Business Mailing Address
First Line	:	8102 COQUINA AVE FL 34951
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-1032
Country	:	US
Telephone Number	:	772-216-3123
Fax Number	:	772-264-6336

Provider Business Practice Location Address
First Line	:	8102 COQUINA AVE FL 34951
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-1032
Country	:	US
Telephone Number	:	772-216-3123
Fax Number	:	772-264-6336

Authorized Official
Title or Position	:	CMO/PROVIDER
Name	:	DIANNA GAIL DASHNER
Credential	:	DNP, ARNP
Telephone Number	:	772-216-3123

Provider Enumeration Date	:	10/07/2025
Last Update Date	:	10/07/2025

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