Provider Demographics
NPI:1093697112
Name:MOBILE WOUND CARE COLLABORATIVE LLC
Entity type:Organization
Organization Name:MOBILE WOUND CARE COLLABORATIVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:VITAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANAGEMENT GROUP LLC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-328-9458
Mailing Address - Street 1:13420 PARKER COMMONS BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-1973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13420 PARKER COMMONS BLVD STE 106
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1973
Practice Address - Country:US
Practice Address - Phone:321-328-9458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty