Healthcare Provider Details

I. General information

NPI: 1760267314
Provider Name (Legal Business Name): FL WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ISLAND AVE APT 1808
MIAMI BEACH FL
33139-1342
US

IV. Provider business mailing address

11 ISLAND AVE APT 1808
MIAMI BEACH FL
33139-1342
US

V. Phone/Fax

Practice location:
  • Phone: 954-638-8615
  • Fax:
Mailing address:
  • Phone: 954-638-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN L SNYDERMAN
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 954-638-8615