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Organization
WOUND AND MEDICAL OUTREACH CLINIC LLC
Active
Organization
WOUND AND MEDICAL OUTREACH CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL M MARSHALL ALLEN (MGMR)
(813) 777-1591
Entity
Organization
Contact information
Practice address
12250 BLUE PACIFIC DR, RIVERVIEW, FL 33579-1803
(813) 777-1591
(800) 351-2611
Mailing address
12250 BLUE PACIFIC DR, RIVERVIEW, FL 33579-1803
(800) 351-2611
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
225100000X
Physical Therapist
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/03/2020
Last updated
11/27/2023
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