Healthcare Provider Details

I. General information

NPI: 1699655480
Provider Name (Legal Business Name): ST. SOMEWHERE WOUND CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3183 FLAMINGO BLVD
HERNANDO BEACH FL
34607-2810
US

IV. Provider business mailing address

3183 FLAMINGO BLVD
HERNANDO BEACH FL
34607-2810
US

V. Phone/Fax

Practice location:
  • Phone: 352-263-6925
  • Fax:
Mailing address:
  • Phone: 352-263-6925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA BOWEN
Title or Position: CREDENTIALING OFFICER
Credential:
Phone: 615-504-1984