Provider Demographics
NPI:1417050824
Name:CENTRAL FLORIDA WOUND & SKIN CONSULTANTS,INC.
Entity Type:Organization
Organization Name:CENTRAL FLORIDA WOUND & SKIN CONSULTANTS,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:FIKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-342-4384
Mailing Address - Street 1:PO BOX 607521
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32860-7521
Mailing Address - Country:US
Mailing Address - Phone:407-359-6426
Mailing Address - Fax:407-359-6426
Practice Address - Street 1:14325 BENDING BRANCH CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824
Practice Address - Country:US
Practice Address - Phone:407-359-6426
Practice Address - Fax:407-359-6426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3110002150163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0005AOtherBC BS OF FLORIDA
FLK1355Medicare PIN