MEDICARE: ADVANCED WOUND CARE, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356036354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED WOUND CARE, LLC

Provider Business Mailing Address
First Line	:	2203 N LOIS AVE STE 814
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-2388
Country	:	US
Telephone Number	:	813-608-5633
Fax Number	:	800-608-5633

Provider Business Practice Location Address
First Line	:	2203 N LOIS AVE STE 814
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-2388
Country	:	US
Telephone Number	:	813-608-5633
Fax Number	:	800-608-5633

Authorized Official
Title or Position	:	MANAGER
Name	:	TIMOTHY WATSON
Credential	:
Telephone Number	:	813-505-5060

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	06/19/2024

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Directions to “ADVANCED WOUND CARE, LLC ” Practice Location

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