PEACE RIVER ANKLE & FOOT, PL
Medical Practice at Conway Blvd, Port Charlotte, FL

License number
Florida PO3264
Category
Medical Practice
Type
Foot & Ankle Surgery
Owner
Name: DR. HOLLY K WADDELL DPM
Title: OWNER/PODIATRIST
Phone: (941) 624-3668
Address
Address
3440 Conway Blvd, Port Charlotte, FL 33952
National Provider ID: 1023329331
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PEACE RIVER ANKLE & FOOT, PL

3440 Conway Blvd UNIT 1D, Port Charlotte, FL 33952

Status:
Inactive
Inactive reason:
LC ARTICLE OF CORRECTION
Registration:
May 17, 2010
Inactive since:
Jun 21, 2010
State ID:
L10000053402
Business type:
Florida Limited Liability Company
Manager:
Holly K Waddell (Manager), 3440 Conway Blvd - UNIT 1D, Port Charlotte, FL 33952 (Physical)
Agent:
Holly Waddell,3440 Conway Blvd, Port Charlotte, FL 33952 (Physical)
EIN:
27-2556410

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