Healthcare Provider Details

I. General information

NPI: 1851818645
Provider Name (Legal Business Name): WANDA JEAN WINARSKI NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 08/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5220 BELFORT RD STE 130
JACKSONVILLE FL
32256-6018
US

IV. Provider business mailing address

105 EVERGREEN CT
COLLINSVILLE IL
62234-4781
US

V. Phone/Fax

Practice location:
  • Phone: 904-446-3760
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2017005252
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2017005252
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: