Healthcare Provider Details

I. General information

NPI: 1760133763
Provider Name (Legal Business Name): EXPRESS WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 ALOMA AVE
WINTER PARK FL
32792-2541
US

IV. Provider business mailing address

2431 ALOMA AVE
WINTER PARK FL
32792-2541
US

V. Phone/Fax

Practice location:
  • Phone: 321-877-8006
  • Fax:
Mailing address:
  • Phone: 321-877-8006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIA DELIZ NIEVES
Title or Position: MANAGER
Credential:
Phone: 321-877-8006