=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821711656
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOUND CARE AT HOME, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2022
-----------------------------------------------------
Last Update Date | 04/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7170 N LECANTO HWY
-----------------------------------------------------
City | HERNANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34442-2022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-739-8400
-----------------------------------------------------
Fax | 352-718-2260
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5
-----------------------------------------------------
City | MASCOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34753-0005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-739-8400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. TAMMY R DEWITT
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 407-739-8400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------