Healthcare Provider Details

I. General information

NPI: 1770428765
Provider Name (Legal Business Name): IHEAL WOUND CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5083 LITTLE RD STE B
TRINITY FL
34655-1326
US

IV. Provider business mailing address

5083 LITTLE RD STE B
TRINITY FL
34655-1326
US

V. Phone/Fax

Practice location:
  • Phone: 727-494-7573
  • Fax: 727-232-2820
Mailing address:
  • Phone: 727-494-7573
  • Fax: 727-232-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DERRICK DUPRE
Title or Position: MEDICAL DIRECTOR
Credential: FAANS
Phone: 727-494-7573