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Organization
IHN PODIATRY SERVICES PLLC
Active
Organization
IHN PODIATRY SERVICES PLLC
Active
Other names
Bedside Wound Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLORIED MARIE EBSWORTH DPM (MEDICAL DIRECTOR)
(305) 781-9667
Entity
Organization
Contact information
Practice address
5304 S FLORIDA AVE STE 408, LAKELAND, FL 33813-2519
(863) 738-6601
(863) 937-3002
Mailing address
5304 S FLORIDA AVE STE 408, LAKELAND, FL 33813-2519
(863) 738-6601
(863) 937-3002
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
—
—
213E00000X
Podiatrist
Primary
—
—
213EP1101X
Primary Podiatric Medicine Podiatrist
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116891200
—
FL
Enumeration date
08/22/2022
Last updated
03/24/2026
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