Healthcare Provider Details

I. General information

NPI: 1427508837
Provider Name (Legal Business Name): WENDY A WHITAKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2016
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PALMETTO ST.
NEW SMYRNA BEACH FL
32168
US

IV. Provider business mailing address

770 W GRANADA BLVD STE 101
ORMOND BEACH FL
32174-5179
US

V. Phone/Fax

Practice location:
  • Phone: 386-424-6400
  • Fax: 386-424-6422
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11038647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: