=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164344370
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDPLUS ADVANCE CARE CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2026
-----------------------------------------------------
Last Update Date | 07/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1583 N MILITARY TRL STE A-2
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-4709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-970-5171
-----------------------------------------------------
Fax | 561-421-5947
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1583 N MILITARY TRL STE A-2
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33409-4709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-970-5171
-----------------------------------------------------
Fax | 561-421-5947
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | LIDICE LEYVA
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 561-248-9446
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WW0000X
-----------------------------------------------------
Taxonomy Name | Wound Care Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------