Organization · NPI-2

Aetherus Wound And Lymphatics PLLC

General Practice · Tampa, FL

NPI number1770413445
StatusActive
Last updated in NPPESJun 23, 2026

Details

NPI
1770413445
Entity type
Organization (NPI-2)
Legal business name
Aetherus Wound And Lymphatics PLLC
Organization subpart
No
Enumeration date
May 22, 2026
Certification date
Jun 23, 2026
Last updated
Jun 23, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208D00000X General Practice––Yes
163WW0000X Registered Nurse, Wound Care––

Practice location

15310 Amberly Dr Ste 195
Tampa, FL 33647-1646

Phone 813-212-6517

Mailing address

15303 Amberly Dr Ste C
Tampa, FL 33647-2308

Phone 813-212-6517 · Fax 813-212-6518

Authorized official

Loan Lam
Owner
8132126517

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