Healthcare Provider Details

I. General information

NPI: 1326913674
Provider Name (Legal Business Name): OKEECHOBEE WOUND AND WELLNESS CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8102 COQUINA AVE FL 34951
FORT PIERCE FL
34951-1032
US

IV. Provider business mailing address

8102 COQUINA AVE FL 34951
FORT PIERCE FL
34951-1032
US

V. Phone/Fax

Practice location:
  • Phone: 772-216-3123
  • Fax: 772-264-6336
Mailing address:
  • Phone: 772-216-3123
  • Fax: 772-264-6336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DIANNA GAIL DASHNER
Title or Position: CMO/PROVIDER
Credential: DNP, ARNP
Phone: 772-216-3123