Healthcare Provider Details

I. General information

NPI: 1710964093
Provider Name (Legal Business Name): LOUISE C WASZAK PHD, ARNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 W US HIGHWAY 90
LAKE CITY FL
32055-8341
US

IV. Provider business mailing address

525 TURKEY CREEK
ALACHUA FL
32615
US

V. Phone/Fax

Practice location:
  • Phone: 386-719-3939
  • Fax:
Mailing address:
  • Phone: 386-462-9907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP 009371
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30008047
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9322769
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP002220D
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberAP30008047
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: