Healthcare Provider Details

I. General information

NPI: 1679167134
Provider Name (Legal Business Name): DEAN HEALTHCARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LAKELAND HILLS BLVD STE 4
LAKELAND FL
33805-3257
US

IV. Provider business mailing address

1500 LAKELAND HILLS BLVD STE 4
LAKELAND FL
33805-3257
US

V. Phone/Fax

Practice location:
  • Phone: 863-937-7157
  • Fax: 863-333-0260
Mailing address:
  • Phone: 863-937-7157
  • Fax: 863-333-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BYRON R DEAN
Title or Position: MANAGER
Credential: DO
Phone: 863-937-7157