JCL Advanced Wound Care LLC
Organization Active NPI Family Nurse Practitioner · Westlake, FL
NPI 1063364693 · NPPES record last updated Mar 26, 2026
Key facts
- NPI
- 1063364693
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- Legal business name
- JCL ADVANCED WOUND CARE LLC
- Practice address
- 4644 Canopy Grove Dr
Westlake, FL 33470-7049 - Phone
- (561) 633-0689
- NPI assigned
- Feb 14, 2026
- Organization subpart
- No
Authorized official
- Name
- Oluwabusayo Omole, MSN, APRN,FNP-BC,CWS
- Title
- Aprn/Nurse Practitioner
- Phone
- (561) 633-0689
Practitioners 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260612001534 | FL | Part B Supplier - Clinic/Group Practice | 9931671765 |
Receives reassigned benefits from 1 practitioner Practice locations: Westlake, FL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | Yes |
Addresses
Primary practice location
4644 Canopy Grove Dr
Westlake, FL 33470-7049
Mailing address
4644 Canopy Grove Dr
Westlake, FL 33470-7049
Other providers in Westlake, FL
- Mitchell David Gruzmark
- H3, PLLC
- Samara Hopkins
- Influential Therapy LLC
- Eugene Jacobs II
- Keli Rochelle Karbowski
- Peter Kerr
- La Casa Family Practice PLLC
- Luxehaven Care
- Mildrey Martinez
All providers in Westlake, FL · Family Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.