Provider Demographics
NPI:1740902220
Name:WOUND CARE SOLUTIONS OF NWFL PLLC
Entity type:Organization
Organization Name:WOUND CARE SOLUTIONS OF NWFL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSHNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-541-3908
Mailing Address - Street 1:126 S SHORE DR UNIT 10
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-5830
Mailing Address - Country:US
Mailing Address - Phone:850-541-3908
Mailing Address - Fax:833-228-6377
Practice Address - Street 1:126 S SHORE DR UNIT 10
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-5830
Practice Address - Country:US
Practice Address - Phone:850-541-3908
Practice Address - Fax:833-228-6377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-13
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty