Provider Demographics
NPI:1700603529
Name:WOUND CARE BY NURSE PRACTITIONERS LLC
Entity type:Organization
Organization Name:WOUND CARE BY NURSE PRACTITIONERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-627-4553
Mailing Address - Street 1:3956 TOWN CTR BLVD STE 323
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6103
Mailing Address - Country:US
Mailing Address - Phone:386-627-4553
Mailing Address - Fax:386-877-2006
Practice Address - Street 1:21 OLD KINGS RD N UNIT 108
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8254
Practice Address - Country:US
Practice Address - Phone:386-627-4553
Practice Address - Fax:386-877-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty