Central Florida Foot and Ankle
Organization Active NPI Foot & Ankle Surgery Podiatrist · Winter Haven, FL
NPI 1093809097 · NPPES record last updated Mar 7, 2008
Key facts
- NPI
- 1093809097
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- License
- PO2760 (FL)
- Legal business name
- CENTRAL FLORIDA FOOT AND ANKLE
- Practice address
- 101 6TH St NW
Winter Haven, FL 33881-4630 - Phone
- (863) 299-4551
- Fax
- (863) 299-2310
- NPI assigned
- Oct 3, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Tatiana A Wellens-Bruschayt, D.P.M, PHD
- Title
- President
- Phone
- (863) 299-4551
Practitioners 7
-
Tatiana Wellens Picot, DPM, PHD
-
Diego Luis Adarve, D.P.M.
-
Narmo Luis Ortiz Jr., D.P.M.
-
Debra C Reardon, P.T.
-
Elizabeth A Rodela, P.T.
-
Carissa J Sica, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041011000208 | FL | Part B Supplier - Clinic/Group Practice | 1254390610 |
Receives reassigned benefits from 2 practitioners Practice locations: Davenport, FL; Lakeland, FL; Winter Haven, FL |
| O20100930082764 | FL | DME Supplier - Physician - Podiatry | 1254390610 | Practice locations: Winter Haven, FL |
National Provider Directory
Locations
1115 Lakeland Hills Blvd
Lakeland, FL 33805
Phone (863) 299-4551
101 6th St NW
Winter Haven, FL 33881
Phone (863) 299-4551
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist |
213ES0103X | PO2760 | FL | Yes |
| Foot & Ankle Surgery Podiatrist |
213ES0103X | PO2804 | FL | |
| Foot & Ankle Surgery Podiatrist |
213ES0103X | PO3070 | FL |
Addresses
Primary practice location
101 6TH St NW
Winter Haven, FL 33881-4630
Mailing address
PO Box 7472
Winter Haven, FL 33883-7472
Phone (863) 299-4551
Other providers in Winter Haven, FL
- Ashley Castro
- Barry Wayne Cayson
- Centerwell Pharmacy, Inc.
- Central Florida ABA Therapy Corp.
- Central Florida Eye Care LLC
- Central Florida Health Care Inc
- Central Florida Health Care Inc
- Central Florida Health Care, Inc
- Central Florida Health Care, Inc.
- Central Florida Health Care, Inc.
All providers in Winter Haven, FL · Foot & Ankle Surgery Podiatrist 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 7, 2008. 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.