MEDICARE: WENDY B DEMKO NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	0024170539	VA
2	363LA2200X	Adult Health Nurse Practitioner	APRN11001845	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780926378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY B DEMKO NP-C

Provider Business Mailing Address
First Line	:	PO BOX 361095
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32936-1095
Country	:	US
Telephone Number	:	321-241-4877
Fax Number	:	321-241-4879

Provider Business Practice Location Address
First Line	:	8057 SPYGLASS HILL RD STE 104
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-8565
Country	:	US
Telephone Number	:	321-241-4877
Fax Number	:	321-241-4879

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2013
Last Update Date	:	07/18/2023

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Directions to “ WENDY B DEMKO NP-C” Practice Location

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