WOUND AND MEDICAL OUTREACH CLINIC LLC (NPI# 1881229532) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881229532 |
| Entity Type | Organization |
| Organization Name | WOUND AND MEDICAL OUTREACH CLINIC LLC |
| Practice Address |
12250 Blue Pacific Dr Riverview FL 33579-1803 |
| Practice Telephone | 8137771591 |
| Practice Fax Number | 8003512611 |
| Mailing Fax Number | 8003512611 |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2020-08-06 |
| Authorized Official Name | JILL M MARSHALL ALLEN (MGMR) |
| Authorized Official Telephone | 8137771591 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WW0000X |
Registered Nurse Specialization: Wound Care |
Nursing Service Providers | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | WOUND AND MEDICAL OUTREACH CLINIC LLC | 12250 Blue Pacific Dr, Riverview, FL 33579-1803 |
| Street Address |
12250 BLUE PACIFIC DR |
| City | RIVERVIEW |
| State | FL |
| Zip Code | 33579-1803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851912505 | Joanna Johnson | Developmental Therapist | 10910 Keys Gate Drive, Riverview, FL 33579 | 2020-05-05 |
| 1255815114 | Advanced Dental Care of Riverview Pllc | Clinic/Center | 13018 S Us Highway 301, Riverview, FL 33579 | 2018-09-18 |
| 1265920078 | Takashi Dixon | Dentist | 10625 Big Bend Rd, Riverview, FL 33579 | 2018-04-26 |
| 1821513243 | Marie Evens Murat | Registered Nurse | 12718 Lovers Lane, Riverview, FL 33579 | 2017-08-07 |
| 1467907857 | Dorothy Araujo | Assisted Living Facility | 11626 Tropical Isle Ln, Riverview, FL 33579 | 2016-08-16 |
| 1134571128 | Tampa Institute for Pain and Spine, LLC | Anesthesiology | 13140 Elk Mountain Dr, Suite B, Riverview, FL 33579 | 2016-07-01 |
| 1669832242 | Shawn Mckeag | Speech-Language Pathologist | 11838 Newberry Grove Loop, Riverview, FL 33579 | 2016-02-25 |
| 1902202377 | Jose Gerena | Adult Companion | 11325 Village Brook Dr, Riverview, FL 33579 | 2014-11-13 |
| 1912259409 | Brandi L Torres | Nurse Practitioner | 10729 Queens Town Drive, Riverview, FL 33579 | 2012-10-08 |
| 1952677700 | Crystal Nache Clark | Counselor | 13902 Sage Thrasher Lane, Riverview, FL 33579 | 2012-03-27 |
| Find all providers in zip 33579 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578171757 | Krystle Danielle Russell | Nurse Practitioner | 9912 Harold Bedford Rd, Riverview, FL 33578-7659 | 2020-07-14 |
| 1902434665 | Evelyn Hamman | Nurse Practitioner | 12201 Morgans Bluff Pl, Riverview, FL 33579-0012 | 2020-03-30 |
| 1417517285 | Gloria Funbi Toyinbo | Nurse Practitioner | 11814 Autumn Creek Dr, Riverview, FL 33569-2001 | 2019-06-14 |
| 1558382960 | Dalisay N. Singh | Nurse Practitioner | 11347 Village Brook Dr, Riverview, FL 33579-7191 | 2006-07-21 |
| 1083264386 | Carmen Valdez | Nurse Practitioner | 6901 Simmons Loop, Riverview, FL 33578-9498 | 2019-09-18 |
| 1235788035 | Trisha Thomas Tucker | Nurse Practitioner | 18580 Fort St, Riverview, MI 48193-7442 | 2019-09-05 |
| 1023585932 | Kimberly Havers | Nurse Practitioner | 6901 Simmons Loop, Riverview, FL 33578-9498 | 2018-10-29 |
| 1487138772 | Rachel M Conner | Nurse Practitioner | 10141 Big Bend Rd Ste 206, Riverview, FL 33578-7422 | 2018-09-21 |
| 1194229351 | Lisa Hansen | Nurse Practitioner | 18580 Fort St, Riverview, MI 48193-7442 | 2018-03-22 |
| 1821503111 | Demetria Lavette Walker-rutledge | Nurse Practitioner | 10141 Big Bend Rd Ste 101, Riverview, FL 33578 | 2017-12-07 |
| Find all providers in RIVERVIEW | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.