SPACECOAST WOUND SPECIALIST LLC
NPI 1417787490
Nurse Practitioner - Gerontology in Palm Bay, FL
About Spacecoast Wound Specialist Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SPACECOAST WOUND SPECIALIST LLC (NPI 1417787490) is a healthcare organization registered as a gerontology in Palm Bay, Florida and active in the NPI registry since August 2024. The organization lists Marianne Arruda-wennberg, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Spacecoast Wound Specialist Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Spacecoast Wound Specialist LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Spacecoast Wound Specialist LLC's NPI number?
The NPI number for Spacecoast Wound Specialist LLC is 1417787490. It was assigned to this organization in the NPPES registry on August 5, 2024.
Where is Spacecoast Wound Specialist LLC located?
Spacecoast Wound Specialist LLC is located at 770 Schuster Rd SW, Palm Bay, FL 32908. The listed phone number is (321) 720-3014.
What is Spacecoast Wound Specialist LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Gerontology, with taxonomy code 363LG0600X.
Is Spacecoast Wound Specialist LLC enrolled in Medicare?
Yes. Spacecoast Wound Specialist LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Spacecoast Wound Specialist LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Spacecoast Wound Specialist LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Spacecoast Wound Specialist LLC was last updated on September 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Spacecoast Wound Specialist Llc · NPI 1417787490
Gerontology organization in Palm Bay, Florida. Organization record, active in the CMS NPPES registry since August 5, 2024.
## Identity
- **NPI:** 1417787490 (Entity type: Organization)
- **Enumerated:** August 5, 2024
- **Primary specialty:** Nurse Practitioner - Gerontology · taxonomy 363LG0600X
- **Organization subpart:** No
- **Authorized official:** Marianne Arruda-Wennberg, OWNER
## Practice location
- **Address:** 770 SCHUSTER RD SW, Palm Bay, FL 32908-1711
- **Phone:** (321) 720-3014
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 5, 2024
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Source: [NPI Profile](https://npiprofile.com/npi/1417787490) · Data from the CMS NPPES public registry.