Healthcare Provider Details

I. General information

NPI: 1558033100
Provider Name (Legal Business Name): PERSONIC HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WINDERLEY PL STE 300
MAITLAND FL
32751-7133
US

IV. Provider business mailing address

PO BOX 8209
VIENNA VA
22183-2058
US

V. Phone/Fax

Practice location:
  • Phone: 251-901-3011
  • Fax: 215-933-6837
Mailing address:
  • Phone: 251-901-3011
  • Fax: 251-901-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: FAHAD HASHMI
Title or Position: OWNER
Credential:
Phone: 251-901-3011