MEDICARE: TAMPA BAY WOUND CARE ASSOCIATES MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WW0000X	Wound Care Registered Nurse

General Provider Information

NPI Number	:	1285401281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAMPA BAY WOUND CARE ASSOCIATES MD PLLC

Provider Business Mailing Address
First Line	:	435 42ND AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-4504
Country	:	US
Telephone Number	:	251-901-3011
Fax Number	:

Provider Business Practice Location Address
First Line	:	435 42ND AVE S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-4504
Country	:	US
Telephone Number	:	251-901-3011
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PASCAL CROSLEY
Credential	:
Telephone Number	:	251-901-3011

Provider Enumeration Date	:	12/08/2023
Last Update Date	:	05/21/2024

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