Healthcare Provider Details

I. General information

NPI: 1568789089
Provider Name (Legal Business Name): NAUTILUS HEALTH CARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W BROAD ST STE 1800
COLUMBUS OH
43215-3301
US

IV. Provider business mailing address

PO BOX 530968
ST PETERSBURG FL
33747-0968
US

V. Phone/Fax

Practice location:
  • Phone: 727-867-5480
  • Fax: 727-867-5470
Mailing address:
  • Phone: 727-823-2188
  • Fax: 727-828-0723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number35.094063
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number35.094063
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number35.094063
License Number StateOH

VIII. Authorized Official

Name: FRANK WILLIAMS
Title or Position: CEO
Credential:
Phone: 904-446-3519