Healthcare Provider Details

I. General information

NPI: 1720962871
Provider Name (Legal Business Name): HEALING IHN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2025
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5304 S FLORIDA AVE STE 408
LAKELAND FL
33813-2519
US

IV. Provider business mailing address

5304 S FLORIDA AVE STE 408
LAKELAND FL
33813-2519
US

V. Phone/Fax

Practice location:
  • Phone: 863-738-6601
  • Fax: 863-937-3002
Mailing address:
  • Phone: 863-738-6601
  • Fax: 863-937-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: GLORIED M EBSWORTH
Title or Position: DIRECTOR
Credential: MD
Phone: 863-738-6601