Healthcare Provider Details

I. General information

NPI: 1144535808
Provider Name (Legal Business Name): ADRIANA WAGNER PMHNP-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 COMMERCE POINT DR
LAKELAND FL
33801-6880
US

IV. Provider business mailing address

2707 PANKAW LN
VALRICO FL
33596-6515
US

V. Phone/Fax

Practice location:
  • Phone: 863-709-8543
  • Fax:
Mailing address:
  • Phone: 813-598-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAP 4364
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberNP11038978
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10983
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberMH10983
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: