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General NPI Number Information
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NPI Number | 1063364693
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Entity Type | Organization
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Legal Business Name | JCL ADVANCED WOUND CARE
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Dates
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Enumeration Date | 02/14/2026
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Last Update Date | 02/14/2026
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Provider Practice Location Address
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Address Line | 4644 CANOPY GROVE DR
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City | WESTLAKE
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State | FL
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Zip | 33470-7049
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Country | US
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Telephone | 561-633-0689
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Fax |
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Provider Business Mailing Address
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Address Line | 4644 CANOPY GROVE DR
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City | WESTLAKE
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State | FL
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Zip | 33470-7049
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | APRN/NURSE PRACTITIONER
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Name | OLUWABUSAYO OMOLE
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Credential | MSN, APRN,FNP-BC,CWS
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Telephone | 561-633-0689
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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