Healthcare Provider Details

I. General information

NPI: 1366382384
Provider Name (Legal Business Name): PAMELA MARIE VICTORIA WAGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 SW 1ST AVE
OCALA FL
34471-6500
US

IV. Provider business mailing address

8454 SE 161ST ST
SUMMERFIELD FL
34491-5555
US

V. Phone/Fax

Practice location:
  • Phone: 352-401-1000
  • Fax:
Mailing address:
  • Phone: 352-812-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberAPRN11046427
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: