Healthcare Provider Details

I. General information

NPI: 1013608330
Provider Name (Legal Business Name): SYLVIA WAGES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 MAR WALT DRIVE UNIT C
FORT WALTON BEACH FL
32547-6706
US

IV. Provider business mailing address

930 MAR WALT DRIVE UNIT C
FORT WALTON BEACH FL
32547-6706
US

V. Phone/Fax

Practice location:
  • Phone: 850-226-6801
  • Fax: 877-413-5104
Mailing address:
  • Phone: 850-226-6801
  • Fax: 877-413-5104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11025383
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: