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General NPI Number Information
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NPI Number | 1356036354
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Entity Type | Organization
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Legal Business Name | ADVANCED WOUND CARE, LLC
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Dates
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Enumeration Date | 04/06/2023
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 2203 N LOIS AVE STE 814
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City | TAMPA
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State | FL
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Zip | 33607-2388
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Country | US
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Telephone | 813-608-5633
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Fax | 800-608-5633
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Provider Business Mailing Address
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Address Line | 2203 N LOIS AVE STE 814
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City | TAMPA
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State | FL
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Zip | 33607-2388
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Country | US
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Telephone | 813-608-5633
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Fax | 800-608-5633
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Authorized Official
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Title or Position | MANAGER
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Name | TIMOTHY WATSON
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Credential |
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Telephone | 813-505-5060
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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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