Healthcare Provider Details

I. General information

NPI: 1285443960
Provider Name (Legal Business Name): WENDY L ROUSE DNP, RN, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 NE 183RD LN
GAINESVILLE FL
32609-4361
US

IV. Provider business mailing address

3511 NE 183RD LN
GAINESVILLE FL
32609-4361
US

V. Phone/Fax

Practice location:
  • Phone: 727-272-0915
  • Fax: 352-289-8291
Mailing address:
  • Phone: 727-272-0915
  • Fax: 352-289-8291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number00056540
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number00056540
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License NumberRN2735832
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2735832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: