Healthcare Provider Details

I. General information

NPI: 1891622585
Provider Name (Legal Business Name): ERICA WADDELL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S DEPARTMENT OF VETERANS AFFAIRS MENTAL HEALTH CLINIC 5465 SW 34TH ST.
GAINESVILLE FL
32608
US

IV. Provider business mailing address

1107 ORCHARD ORIOLE PL
MIDDLEBURG FL
32068-8782
US

V. Phone/Fax

Practice location:
  • Phone: 352-384-3560
  • Fax:
Mailing address:
  • Phone: 904-463-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11047249
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: