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General NPI Number Information
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NPI Number | 1962396424
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Entity Type | Organization
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Legal Business Name | SOUTHWEST FLORIDA ADVANCED WOUND CARE, LLC
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 1813 PALACO GRANDE PKWY
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City | CAPE CORAL
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State | FL
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Zip | 33904-4445
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Country | US
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Telephone | 386-212-4142
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Fax |
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Provider Business Mailing Address
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Address Line | 1907 MENDOCINO LN
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City | PORT ORANGE
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State | FL
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Zip | 32128-7409
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Country | US
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Telephone | 386-212-4142
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JESSICA GAILBREATH
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Credential |
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Telephone | 386-212-4142
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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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