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General NPI Number Information
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NPI Number | 1518136548
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Entity Type | Organization
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Legal Business Name | WOUND THERAPY PROFESSIONALS, INC
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 10/16/2013
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Provider Practice Location Address
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Address Line | 12750 JUDY ST
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City | DADE CITY
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State | FL
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Zip | 33525-8323
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Country | US
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Telephone | 813-966-4722
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 290046
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City | TEMPLE TERRACE
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State | FL
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Zip | 33687-0046
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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 | PRESIDENT
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Name | MICHAL NIZAN
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Credential | ARNP-C
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Telephone | 813-966-4722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ARNP 1927792
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License Number State | FL
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