Healthcare Provider Details

I. General information

NPI: 1669188173
Provider Name (Legal Business Name): A2Z MOBILE FISTULA OSTOMY & WOUND SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 METROCENTRE BLVD STE 1
WEST PALM BEACH FL
33407-3100
US

IV. Provider business mailing address

2580 METROCENTRE BLVD STE 1
WEST PALM BEACH FL
33407-3100
US

V. Phone/Fax

Practice location:
  • Phone: 561-814-8700
  • Fax: 561-812-3763
Mailing address:
  • Phone: 561-814-8700
  • Fax: 561-812-3763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SONIA HANKERSON
Title or Position: ADMINSTRATOR
Credential:
Phone: 954-599-9537