Healthcare Provider Details

I. General information

NPI: 1629267091
Provider Name (Legal Business Name): WENDY M FLANAGAN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 8TH AVE
GAINESVILLE FL
32601-5059
US

IV. Provider business mailing address

PO BOX 25
HAWTHORNE FL
32640-0025
US

V. Phone/Fax

Practice location:
  • Phone: 352-336-0872
  • Fax: 352-481-3735
Mailing address:
  • Phone: 352-336-0872
  • Fax: 352-481-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMA34335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: