Healthcare Provider Details

I. General information

NPI: 1770344756
Provider Name (Legal Business Name): SKP WOUND CARE OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SOUTHERN OAKS DR STE B
PLANT CITY FL
33563-1446
US

IV. Provider business mailing address

304 E PINE ST STE 1037
LAKELAND FL
33801-4969
US

V. Phone/Fax

Practice location:
  • Phone: 337-581-2612
  • Fax:
Mailing address:
  • Phone: 337-581-2612
  • 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 TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TYLER STOUT
Title or Position: MANGER
Credential:
Phone: 337-315-7927