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General NPI Number Information
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NPI Number | 1073231353
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Entity Type | Organization
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Legal Business Name | IHN PODIATRY SERVICES PLLC
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 5304 S FLORIDA AVE STE 406
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City | LAKELAND
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State | FL
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Zip | 33813-4914
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Country | US
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Telephone | 863-738-6601
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Fax |
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Provider Business Mailing Address
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Address Line | 5304 S FLORIDA AVE STE 400F
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City | LAKELAND
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State | FL
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Zip | 33813-4914
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Country | US
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Telephone | 863-738-6601
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MRS. GLORIED EBSWORTH
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Credential | DPM
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Telephone | 305-781-9667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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