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NPI Code Detail

MEDICARE: MS. JUDITH MARY WAGONER NP

MEDICARE: MS. JUDITH MARY WAGONER NP
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
1363LF0000XFamily Nurse PractitionerARNP9360341FL

Other Identifiers

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

General Provider Information

NPI Number : 1831468719
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JUDITH MARY WAGONER NP
Provider Business Mailing Address
First Line : PO BOX 2147
Second Line :
City : FORT MYERS
State : FL
Zip : 33902-2147
Country : US
Telephone Number : 239-343-3174
Fax Number : 239-343-3495
Provider Business Practice Location Address
First Line : 9131 COLLEGE POINTE CT
Second Line :
City : FORT MYERS
State : FL
Zip : 33919-3245
Country : US
Telephone Number : 239-343-9100
Fax Number : 239-343-9108
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2011
Last Update Date : 03/30/2021

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