Provider Demographics
NPI:1356234504
Name:BROWARD WOUND CARE SPECIALIST LLC
Entity type:Organization
Organization Name:BROWARD WOUND CARE SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PD
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-638-8615
Mailing Address - Street 1:7950 SW 30TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1979
Mailing Address - Country:US
Mailing Address - Phone:954-638-8615
Mailing Address - Fax:
Practice Address - Street 1:7950 SW 30TH ST STE 201
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-1979
Practice Address - Country:US
Practice Address - Phone:954-638-8615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty