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General NPI Number Information
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NPI Number | 1457177222
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Entity Type | Organization
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Legal Business Name | PRECISION WOUND CARE OF FLORIDA LLC
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 5880 49TH ST N STE S104B
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City | ST PETERSBURG
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State | FL
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Zip | 33709-2150
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Country | US
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Telephone | 727-594-7386
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Fax |
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Provider Business Mailing Address
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Address Line | 5880 49TH ST N STE S104B
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City | ST PETERSBURG
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State | FL
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Zip | 33709-2150
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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 | OWNER
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Name | HERMAN CORNELIUS SALLEY II
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Credential |
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Telephone | 727-594-7386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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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 | 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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