Provider Demographics
NPI:1013562735
Name:COMPREHENSIVE WOUND MANAGEMENT LLC
Entity type:Organization
Organization Name:COMPREHENSIVE WOUND MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:PEARL
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:561-513-1379
Mailing Address - Street 1:3330 FAIRCHILD GARDENS AVE
Mailing Address - Street 2:STE 30451
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5417
Mailing Address - Country:US
Mailing Address - Phone:561-513-1376
Mailing Address - Fax:
Practice Address - Street 1:4346 DAFFODIL CIR S
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-5417
Practice Address - Country:US
Practice Address - Phone:561-541-2536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5412536Medicaid