MEDICARE: FLORIDA WOUND CARE GROUP 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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1386495596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA WOUND CARE GROUP LLC

Provider Business Mailing Address
First Line	:	411 NORTHWEST BLVD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-4166
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 NORTHWEST BLVD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-4166
Country	:	US
Telephone Number	:	786-344-2394
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MERY MELO
Credential	:	APRN
Telephone Number	:	786-344-2394

Provider Enumeration Date	:	03/27/2024
Last Update Date	:	03/27/2024

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