Healthcare Provider Details

I. General information

NPI: 1740195510
Provider Name (Legal Business Name): NORTHEAST FLORIDA LIMB PRESERVATION AND COMPLEX WOUND CARE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 SAN JUAN AVE STE 2
JACKSONVILLE FL
32210-2856
US

IV. Provider business mailing address

6420 SAN JUAN AVE STE 2
JACKSONVILLE FL
32210-2856
US

V. Phone/Fax

Practice location:
  • Phone: 904-929-2010
  • Fax: 904-929-2014
Mailing address:
  • Phone: 904-929-2010
  • Fax: 904-929-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROL BOWEN-WELLS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 904-929-2010