Provider Demographics
NPI:1770347411
Name:INTEGRATED WOUND CARE OF CENTRAL FLORIDA LLC
Entity type:Organization
Organization Name:INTEGRATED WOUND CARE OF CENTRAL FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN, FNP-BC COMPANY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCTAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:352-426-3471
Mailing Address - Street 1:2827 NE 31ST PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34479-3081
Mailing Address - Country:US
Mailing Address - Phone:352-512-1588
Mailing Address - Fax:
Practice Address - Street 1:2827 NE 31ST PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34479-3081
Practice Address - Country:US
Practice Address - Phone:352-512-1588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty