Healthcare Provider Details

I. General information

NPI: 1366421059
Provider Name (Legal Business Name): TATIANA WELLENS PICOT DPM, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TATIANA A WELLENS-BRUSCHAYT

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 6TH ST NW
WINTER HAVEN FL
33881-4630
US

IV. Provider business mailing address

101 6TH ST NW
WINTER HAVEN FL
33881-4630
US

V. Phone/Fax

Practice location:
  • Phone: 863-299-4551
  • Fax: 863-299-2310
Mailing address:
  • Phone: 863-299-4551
  • Fax: 863-299-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO2760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: