Healthcare Provider Details

I. General information

NPI: 1417050824
Provider Name (Legal Business Name): CENTRAL FLORIDA WOUND & SKIN CONSULTANTS,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14325 BENDING BRANCH CT
ORLANDO FL
32824
US

IV. Provider business mailing address

PO BOX 607521
ORLANDO FL
32860-7521
US

V. Phone/Fax

Practice location:
  • Phone: 407-359-6426
  • Fax: 407-359-6426
Mailing address:
  • Phone: 407-359-6426
  • Fax: 407-359-6426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number3110002150
License Number StateFL

VIII. Authorized Official

Name: MS. MARY T FIKERT
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 407-342-4384