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General NPI Number Information
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NPI Number | 1922975846
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Entity Type | Organization
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Legal Business Name | EVOLUTION WOUND MANAGEMENT OF FL PA
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Dates
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Enumeration Date | 10/23/2025
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 7901 4TH ST N STE 300
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4399
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Country | US
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Telephone | 800-914-3592
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Fax | 800-897-1470
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Provider Business Mailing Address
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Address Line | 242 W 53RD ST APT 48E
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City | NEW YORK
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State | NY
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Zip | 10019-7895
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Country | US
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Telephone | 800-914-3592
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Fax | 800-897-1470
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOSHUA ALAN EMDUR
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Credential | D.O
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Telephone | 800-914-3592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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