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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