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General NPI Number Information
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NPI Number | 1699655480
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Entity Type | Organization
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Legal Business Name | ST. SOMEWHERE WOUND CARE
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Dates
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Enumeration Date | 09/03/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 3183 FLAMINGO BLVD
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City | HERNANDO BEACH
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State | FL
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Zip | 34607-2810
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Country | US
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Telephone | 352-263-6925
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Fax |
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Provider Business Mailing Address
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Address Line | 3183 FLAMINGO BLVD
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City | HERNANDO BEACH
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State | FL
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Zip | 34607-2810
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Country | US
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Telephone | 352-263-6925
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING OFFICER
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Name | MIRANDA BOWEN
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Credential |
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Telephone | 615-504-1984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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