Healthcare Provider Details

I. General information

NPI: 1427961143
Provider Name (Legal Business Name): FAMILY MEDICAL AND ADVANCED WOUND MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 PURPLE DR
FAYETTEVILLE NC
28314-8494
US

IV. Provider business mailing address

1941 PURPLE DR
FAYETTEVILLE NC
28314-8494
US

V. Phone/Fax

Practice location:
  • Phone: 561-927-5046
  • Fax: 910-919-3902
Mailing address:
  • Phone: 561-927-5046
  • Fax: 910-919-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DENISE ROLLE
Title or Position: NP
Credential: NP
Phone: 561-927-5046