Healthcare Provider Details

I. General information

NPI: 1538018262
Provider Name (Legal Business Name): GULF COAST VEIN AND WOUND CARE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 VINDALE RD
TAVARES FL
32778-5602
US

IV. Provider business mailing address

13 CROSSANDRA DR
HOMOSASSA FL
34446-8416
US

V. Phone/Fax

Practice location:
  • Phone: 352-414-5987
  • Fax:
Mailing address:
  • Phone: 352-414-5987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY PAULLIN
Title or Position: CEO
Credential: ARNP
Phone: 904-434-0739