Healthcare Provider Details

I. General information

NPI: 1710874391
Provider Name (Legal Business Name): CENTRAL FLORIDA WOUND AND DERM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MAITLAND CENTER PKWY STE 310
MAITLAND FL
32751-7442
US

IV. Provider business mailing address

2400 MAITLAND CENTER PKWY STE 310
MAITLAND FL
32751-7442
US

V. Phone/Fax

Practice location:
  • Phone: 407-426-4800
  • Fax: 407-426-4820
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KACIAN BROWN
Title or Position: OWNER
Credential: MD
Phone: 407-426-4800